Non-Specific Low Back Pain in South Australian Public Hospital Emergency Departments: A Retrospective Observational...

Low back pain (LBP) is a leading cause of disability and a common reason for emergency department (ED) presentation. Although clinical guidelines recommend community-based treatment for non-specific LBP, a range of factors drive people to seek hospital-based care in Australia. This study aimed to describe the patient flow, hospital resource utilisation, and economic impact of LBP-related presentations to South Australian public hospital EDs to identify clinical and financial levers to support innovation.

This retrospective observational study utilised data from public hospitals using the electronic medical record over four fiscal years (FY19/20-FY22/23). Systematised Nomenclature of Medicine-Clinical Terms (SNOMED) diagnosis and International Classification of Disease (ICD) codes were used to identify episodes of care where individuals were assigned a primary diagnostic code of LBP and/or sciatica on admission or discharge. Serious spinal pathologies were excluded. Cost of care was calculated using recognised health system metrics (National Weighted Activity Units (NWAU) calculator, estimated ambulance transfer costs).

Ambulance transfer, semi-/non-urgent triage and presentation during office hours were common. Imaging and allied health consultations were low. Opioid prescription was the primary treatment identified, and this increased (frequency, potency) over time. Few patients required admission. Average 'per patient' costing increased by $426.30/patient over the 4-year period.

ED-based care for non-specific LBP was typically non-urgent care with limited evidence-based components and rising per-patient costs. The elevated prescribing practices, limited access to evidence-based care, and rising per-patient costs highlight an urgent need to reform LBP care pathways to enhance patient outcomes and system performance.