Evidence map›Paper›PMID 21030902›Full record

ArticleSpine2010

Diagnostic testing and treatment of low back pain in United States emergency departments: a national perspective.

Benjamin W Friedman, Mikaela Chilstrom, Polly E Bijur, E John Gallagher

2 registry-linked trialsOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Spine, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 64 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
64citing papers in PubMed, 7 pooled it
5.9field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03301623 nacompletednot on this mapstarted 2017, after this paper: background citation

Integrating the Patient Voice Into Comparative Effectiveness Trial of Communication Strategies in the Management of Chronic Pain

TypeinterventionalSponsorCedars-Sinai Medical CenterRan2017 to 2019Enrolled983ConditionsChronic PainArmsClinical Decision Support, Patient Education and Activation Tools
NCT04704297 phase4recruitingnot on this mapstarted 2020, after this paper: background citation

Trigger Point Injection for Myofascial Pain Syndrome in the Low Back (T-PIMPS): A Randomized Controlled Trial.

TypeinterventionalSponsorMadigan Army Medical CenterRan2020 to 2022Enrolled180ConditionsLow Back Pain, Myofascial Pain Syndrome Lower BackArmsTreatment of Myofascial Pain Syndrome in the low back. This intervention will be based on outcomes of the medications listed below., Evaluation of functional ability using a patient centered functional score known as the Modified Oswestry Disability Index (MODI). The intervention will be based on outcomes of medications below., Following up with participants 60-72 hours after treatment in the Emergency Department. This intervention will be based on outcomes of the medications listed below.
3 · Its place in the literature

Who cites it

64 citing papers in PubMed, 7 syntheses or guidelines pooled it, 202 citations in OpenAlex.

  1. Pooled it
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  3. Systemic corticosteroids for radicular and non-radicular low back pain.The Cochrane database of systematic reviews · 2022
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  6. Guideline
  7. Herbal medicine for low-back pain.The Cochrane database of systematic reviews · 2014
    Pooled it
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4 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Benjamin W FriedmanDepartment of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. befriedm@montefiore.org
Mikaela Chilstrom
Polly E Bijur
E John Gallagher
Montefiore Medical Center · US

Funding

Optimizing the Emergency Department diagnosis and treatment of migrainesK23NS051409 · NINDS · MONTEFIORE MEDICAL CENTER (BRONX, NY) · PI FRIEDMAN, BENJAMIN WOLKIN · 2006 to 2010
$729k
NINDS NIH HHS 1K23NS051409NINDS NIH HHS K23 NS051409
6 · The paper itself

Abstract

STUDY

designThis study is an analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS), a large sample representative of all emergency department (ED) visits throughout the United States.

objectiveTo use NHAMCS to describe the frequency of ED visits for the treatment of low back pain, and the diagnostic and therapeutic strategies employed by emergency clinicians. SUMMARY OF BACKGROUND DATA: Low back pain is common in the general population. While it accounts for 2.5% of all outpatient office visits, the role of the ED has yet to be described.

methodsWe included cases if they had both a reason for visit related to back pain and a primary ED discharge ICD9 code consistent with low back pain. The outcomes included frequency of ED use, and frequency of various diagnostic and therapeutic strategies. Individual patient visits are weighted so that data can be extrapolated to all ED visits throughout the United States.

resultsLow back pain related disorders caused 2.63 million (95% CI: 2.32, 2.93 million) annual ED visits in the US. Of all patients with low back pain, 30.5% (28.1, 32.9) had a plain radiograph; 9.6% (95% CI: 7.2, 12.6) had a CT or MRI in 2006 compared with 3.2% (95% CI: 2.0, 5.1) in 2002 (P for trend <0.01). Age and type of insurance were associated with advanced imaging, though geographic region was not. Of medications either administered in the ED or prescribed at discharge, the most frequently used classes were opioids (61.0%, 95% CI: 58.4, 63.5), followed by nonsteroidal anti-inflammatory drugs (49.9%, 95% CI: 47.2, 52.7) and muscle relaxants (43.1%, 95% CI: 40.4, 45.8).

conclusionLow back pain related disorders are a frequent cause of ED visit. Diagnostic imaging is performed in one-third of all patients. There was a strong secular trend in use of advanced imaging; patients were nearly 3 times as likely to receive a CT or MRI in 2006 as they were 4 years earlier. Although opioids were administered or prescribed to two-thirds of patients, use of therapeutic agents was generally in keeping with guideline recommendations.

Indexed as

Diagnostic ImagingAdultAge FactorsAmbulatory CareAnalgesicsDrug PrescriptionsDrug UtilizationEmergency Service, HospitalFemaleGuideline AdherenceHealth Care SurveysHumansInsurance, HealthLogistic ModelsLow Back PainMagnetic Resonance ImagingAnalgesics

Identifiers

PMID21030902
PMCPMC2982879
OpenAlexW2017820684

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.