Prevalence of low back pain in emergency settings: a systematic review and meta-analysis

Abstract

Background: Low back pain may be having a significant impact on emergency departments around the world. Research suggests low back pain is one of the leading causes of emergency department visits. However, in the peer-reviewed literature, there has been limited focus on the prevalence and management of back pain in the emergency department setting. The aim of the systematic review was to synthesize evidence about the prevalence of low back pain in emergency settings and explore the impact of study characteristics including type of emergency setting and how the study defined low back pain.

Methods: Studies were identified from PubMed and EMBASE, grey literature search, and other sources. We selected studies that presented prevalence data for adults presenting to an emergency setting with low back pain. Critical appraisal was conducted using a modified tool developed to assess prevalence studies. Meta-analyses and a meta-regression explored the influence of study-level characteristics on prevalence.

Results: We screened 1187 citations and included 21 studies, reported between 2000 and 2016 presenting prevalence data from 12 countries. The pooled prevalence estimate from studies of standard emergency settings was 4.39% (95% CI: 3.67-5.18). Prevalence estimates of the included studies ranged from 0.9% to 17.1% and varied with study definition of low back pain and the type of emergency setting. The overall quality of the evidence was judged to be moderate as there was limited generalizability and high heterogeneity in the results.

Conclusion: This is the first systematic review to examine the prevalence of low back pain in emergency settings. Our results indicate that low back pain is consistently a top presenting complaint and that the prevalence of low back pain varies with definition of low back pain and emergency setting. Clinicians and policy decisions makers should be aware of the potential impact of low back pain in their emergency settings.

Fig. 1

Flow chart of the selection of studies to be included in our systematic review

Fig. 2

Random effects meta-analyses of prevalence estimates from included studies with standard emergency settings (n = 16)

Fig. 3

Random effects meta-analyses of prevalence estimates from included studies with standard emergency settings (n = 16). The pooled estimate (red line) is representative of the 16 studies included in each subgroup. Studies are grouped by the approach used to define the definition of low back pain: Meta-analysis 1 – Studies grouped by coding system used for the definition of low back pain, 1a “Complaint” indicates studies using presenting complaints for their definitions of low back pain, 1b “Diagnosis” indicates studies using diagnosis codes for their definition. Meta analysis 2- Studies are grouped by healthcare system funding, 2a “Private” indicates studies conducted in regions with private healthcare funding. 2b “Public” indicates studies conducted in regions with public healthcare funding. Meta analysis 3- Studies are grouped by definition of low back pain, 3a “Narrow” indicates studies using narrow definitions of low back pain. They used a definition of ‘low back pain’ or ‘non-specific low back pain’, or were limited to pain complaints in the lumbar region. 3b “Broad” indicates studies using broad definitions of low back pain. They used a general definition of ‘back pain’ to define their prevalence estimate, which may have included some individuals with back pain in regions other than the low back pain (for example, thoracic spine)