Osteopathic manipulative medicine among injured emergency department patients: a nationwide study

Osteopathic manipulative treatment (OMT) encompasses a wide range of diagnostic and treatment techniques for many conditions, but few studies have evaluated OMT use on injured patients.

We aimed to describe the use of OMT on injured patients from a nationwide sample of emergency department (ED) encounters.

We performed a retrospective analysis of the 2018-2022 Nationwide Emergency Department Sample (NEDS) datasets. We included all ED encounters with an injury diagnosis as well as an osteopathic diagnosis or treatment, including International Classification of Diseases - Tenth Revision (ICD-10) Clinical Modification (CM) codes M9900-M9909, ICD-10 Procedure Coding System (PCS) codes 7W00X07-7W09X9Z, and Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) codes 98925-98929. We calculated the Injury Severity Score (ISS) and the predicted probability of injury-related in-hospital mortality for each encounter utilizing the ROCmax method. Except for counts, all statistics at the encounter level are weighted to account for the complex survey design.

Among 29,966,447 ED encounters with an injury diagnosis within the study period, we identified 1,686 with at least one osteopathic diagnosis or treatment code, 6.0 per 100k injury encounters (95 % confidence interval [CI] 4.2 to 8.2). A minority of encounters (574 [35.5 %]) were at level 1 or 2 trauma centers. Although 677 (39.7 %) were admitted, the median ISS was only 1 (interquartile range [IQR 1, 4]), and only 62 (2.9 %) had computed tomography (CT) orders. The predicted probability of injury-related mortality was low, 1.5 % (IQR 1.3, 2.0). Most encounters had a somatic dysfunction diagnosis without an osteopathic treatment code, 1,239 (75.9 %). The most common site of injury, as well as the body area with somatic dysfunction diagnosis and osteopathic treatment, was the thorax.

In this nationwide sample, few injured ED patients received OMT, the majority only received a somatic dysfunction diagnosis without osteopathic treatment, and most had minor injuries. These results offer real-world insights into the use of OMT among injured ED patients and may inform efforts to promote its adoption.