Gold Coast Hospital and Health Service, Southport, Queensland, Australia.
Bond Institute of Health Sciences, Bond University, Gold Coast, Queensland, Australia.
Australas J Ageing. 2023 Dec;42(4):742-750. doi: 10.1111/ajag.13240. Epub 2023 Oct 5.
To determine whether differences exist for older persons presenting to Emergency Departments (EDs) with lower back pain (LBP) in terms of management, health service resource use and cost when compared to younger patients with LBP.
Retrospective analysis of routinely collected electronic medical record data from January 2015 to July 2021. Data from 11,098 adults presenting with LBP to two large regional Australian EDs were analysed over a 5-year period. Rates of presentation, investigation, medication use, spinal surgery and cost were assessed for all participants with respect to age groups (over or under 65 years of age), diagnosis and time. Multivariable logistic regression analysis was employed to assess the contribution of presentation characteristics to the risk of inpatient admission and to investigate the variable effect of patient age.
Older people represented 23% (n = 2565) of all LBP presentations, with a growing proportion of presentations over time. More than 1 in 4 patients over 65 were admitted (n = 703, 27%), with CT imaging being proportionately three times more prevalent (24% vs. 6%), and average cost double (AU$3973 vs. $1671) that of the younger population. Consultation by an ED physiotherapist was associated with lower admission risk across all adult presentations (OR 0.52, 95% CI [0.40 to 0.67]).
Older persons are over-represented amongst gradually increasing rates of LBP presentations to EDs and associated with escalating cost of care and hospital resource use. Older patients present a different clinical and economic profile to younger patients, supporting the provision of individualised management recommendations.
比较老年和年轻腰痛患者在急诊科（ED）就诊时的管理、卫生服务资源利用和成本，以确定老年患者是否存在差异。
回顾性分析 2015 年 1 月至 2021 年 7 月期间常规收集的电子病历数据。对 2 家澳大利亚大型地区急诊科的 11098 例腰痛成年患者进行了 5 年的数据分析。根据年龄组（65 岁以上或以下）、诊断和时间评估所有患者的就诊率、检查、药物使用、脊柱手术和成本。多变量逻辑回归分析用于评估就诊特征对住院风险的影响，并研究患者年龄的可变影响。
老年人占所有腰痛就诊者的 23%（n=2565），随着时间的推移，就诊人数逐渐增加。超过 1/4 的 65 岁以上患者被收治入院（n=703，27%），CT 成像的比例高出三倍（24%比 6%），平均费用是年轻人群的两倍（澳元 3973 比 1671）。在所有成年患者中，ED 物理治疗师的咨询与降低入院风险相关（OR 0.52，95%CI [0.40 至 0.67]）。
老年人在逐渐增加的腰痛急诊科就诊率中占比较高，与医疗成本和医院资源使用的增加相关。老年患者与年轻患者的临床和经济特征不同，支持提供个体化的管理建议。
