Usual Care for Low Back Pain at United States Emergency Departments, 2016-2022

Low back pain is a common reason for visiting the emergency department (ED). Updated and reliable national estimates of usual care for low back pain are needed to identify research and quality improvement priorities to improve patient outcomes and reduce low-value emergency care.

This is a cross-sectional study of the National Hospital Ambulatory Medical Care Survey from 2016 to 2022. We identified ED visits with a back pain-related reason for visit and used the National Hospital Ambulatory Medical Care sampling weights to produce national estimates of usual diagnostic and therapeutic care variables.

From 2016 to 2022, there were an estimated 52.8 million ED visits for low back pain (mean age 45.4 years, 60.3% women, 56.4% non-Hispanic White, and 31.1% Medicaid), accounting for 5.3% of all ED visits. The mean numeric pain score of ED visits for back pain was 7.2 out of 10; 13.7% of visits arrived by ambulance and 40.4% were related to injury or trauma. Mean waiting room time and total ED length of stay were 36.5 and 236.6 minutes, respectively. In 2016, opioids were administered or prescribed in 35.0% and 32.5% of visits for back pain, respectively, and by 2022, opioids were administered or prescribed in 24.5% and 13.5% of visits, respectively. Radiographs were obtained in 39.4% of ED visits. Both opioid prescribing and radiographs were most prevalent in patients 75 years or older.

This study presents updated and reliable national estimates of usual diagnostic and therapeutic emergency care for low back pain from 2016 to 2022, which may be used for national benchmarking and quality improvement efforts.