Ambulance service use by patients with lower back pain: an observational study.

Background: Lower back pain (LBP) is the leading cause of disability globally and can be distressing for patients. It is commonly reported that serious pathologies underlying LBP are rare and most patients would be more appropriately managed in primary care. However, recent literature suggests patients accessing emergency care may differ from those accessing primary care. Currently, little is known about the use of ambulance services by people with LBP. The aim of this study was to investigate the extent and nature of ambulance services utilisation by patients presenting with LBP. Methods: This observational study is a retrospective analysis of ambulance service calls in the North East of England presenting with LBP from 1 August 2016 to 31 July 2017 (Health Research Authority registration 17/WS/0216). Results: Of 484,495 answered calls, 3315 (0.7%) calls were categorised as initially presenting with LBP. Women represented 59% of callers. Most calls were from those aged 41-50 and 71-80 years old. Almost half of patients (48%) initially presenting with LBP were later categorised with a problem elsewhere. Of the patients, 49% received analgesia, including Entonox (24%) and morphine (13%). Most patients (69%) were transported to an emergency department while 28% remained at home. Conclusion: LBP is a relatively common reason to call the ambulance service. Contrary to data from primary care, non-spinal causes, which include medical emergencies, make up a significant proportion of this. Current guidance on back pain focuses on primary care and specialist settings. Future updates may need to consider emergency care as a distinct setting with a potentially different patient population.