COVID-19 对急诊科腰痛患者管理的影响。
Effect of COVID-19 on management of patients with low back pain in the emergency department.
机构信息
Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
出版信息
Australas Emerg Care. 2022 Jun;25(2):154-160. doi: 10.1016/j.auec.2021.07.001. Epub 2021 Jul 8.
BACKGROUND
Patients presenting to Emergency Department (ED) with non-specific low back pain can receive more unnecessary, intensive and costly care than is recommended. The COVID-19 pandemic has provided an unprecedented opportunity to examine how health systems prioritise necessary care that provides clear benefits to patients. The purpose of this study was to examine the impact of COVID-19 on care of low back pain in the ED.
METHODS
We performed a retrospective analysis of electronic medical record data on care for low back pain from three public hospitals in Sydney. We included patients diagnosed with spinal conditions who presented between March and May in 2019 and in 2020. Outcomes were the total number of patients presenting with spinal conditions to ED, the proportion diagnosed with non-specific low back pain, and the proportion receiving potentially unnecessary aspects of care (ambulance use, imaging, opioids, hospital admissions). We calculated relative risk with 95% CIs and examined plots with locally weighted smoothed curves.
RESULTS
Presentations for spinal conditions over a three-month period to three EDs reduced from 694 in 2019 to 475 in 2020 (31% reduction, 95% CI = 26%-37%). The proportion of patients diagnosed with non-specific low back pain (83% in 2019 vs 86% in 2020), or receiving potentially unnecessary care were similar in 2019 and 2020 (Imaging = 25% vs 25%; Opioids = 54% vs 56%; Admitted = 18% vs 20%; pathology test = 24% vs 23%). The proportion of patients arriving by ambulance was higher during the pandemic; 29% in 2019 vs 41% in 2020 (RR = 1.39, 95% CI = 1.19-1.63).
CONCLUSIONS
ED presentations for low back pain associated with spinal conditions decreased substantially during the COVID-19 pandemic. Use of potentially unnecessary aspects of care did not change or increased during the pandemic.
背景
急诊科（ED）出现非特异性下腰痛的患者可能会接受比建议的更不必要、更密集和更昂贵的治疗。COVID-19 大流行提供了一个前所未有的机会，来检验卫生系统如何优先考虑为患者提供明确益处的必要护理。本研究旨在检查 COVID-19 对 ED 中腰痛护理的影响。
方法
我们对来自悉尼三家公立医院的电子病历数据进行了回顾性分析，纳入了 2019 年 3 月至 5 月和 2020 年期间诊断为脊柱疾病的就诊患者。结局为 ED 就诊的脊柱疾病患者总数、诊断为非特异性下腰痛的比例以及接受潜在不必要治疗（救护车使用、影像学检查、阿片类药物、住院）的比例。我们计算了相对风险比（95%置信区间），并检查了局部加权平滑曲线的图。
结果
三个月内，三家 ED 因脊柱疾病就诊的患者从 2019 年的 694 例减少到 2020 年的 475 例（减少 31%，95%CI=26%-37%）。2019 年和 2020 年诊断为非特异性下腰痛的患者比例（分别为 83%和 86%）或接受潜在不必要治疗的患者比例相似（影像学检查=25% vs 25%；阿片类药物=54% vs 56%；住院=18% vs 20%；病理检查=24% vs 23%）。疫情期间，乘坐救护车的患者比例更高，2019 年为 29%，2020 年为 41%（RR=1.39，95%CI=1.19-1.63）。
结论
COVID-19 大流行期间，与脊柱疾病相关的 ED 下腰痛就诊显著减少。在大流行期间，潜在不必要的治疗措施并未减少或增加。
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