Kjeldgaard Mikkel, Schiøttz-Christensen Berit, Thomsen Janus Nikolaj Laust, Skovsgaard Christian Volmar, Bjarkam Carsten Reidies
Department of Neurosurgery, Department of Clinical Medicine, Aalborg University Hospital, 9000, Aalborg, Denmark.
Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Acta Neurochir (Wien). 2025 May 1;167(1):129. doi: 10.1007/s00701-025-06546-z.
To examine primary referral patterns and return to work in patients with incident back pain due to Lumbar Disc Herniation (LDH).
Nationwide register-based cohort study including all Danish residents aged 18-65 who were referred from primary to specialized healthcare in 2017 with incident back pain and subsequently received a diagnosis of lumbar disc herniation (LDH), defined by ICD-10 codes DM51X.X. Patients were identified using the Danish National Patient Registry (DNPR), including both those directly diagnosed with LDH and those who initially received a diagnosis of nonspecific low back pain (ICD-10: DM54) that progressed to LDH within one year. Demographic data were obtained from the Danish Civil Registration System (CRS), and work capacity outcomes were assessed over a two-year follow-up using the Danish Register for Evaluation of Marginalization (DREAM).
A total of 30,082 persons, corresponding to 0.8% of the Danish population aged 18-65, were referred from primary health care to specialized health care with incident back pain and a final diagnosis of LDH. Of these, 5356 (17.8%) were referred to an emergency department, 14,628 (48.6%) to a medical department, and 10,098 (33.6%) to a surgical department. However, the admission rate and the initial department referred to varied widely between regions. Overall, 1915 (6.4%) underwent surgery. Surgical departments operated more frequently on patients with previous high (11%) or intermediate (14%) work capacity than on those with low work capacity (4%), although the latter were more often referred for surgical evaluation. Over 80% of patients with high or intermediate work capacity maintained or returned to work within a year.
In Denmark, referral from primary to specialized health care of patients with incident back pain due to LDH varies considerable between regions highlighting the need for more standardized referral pathways. Specifically, ensuring a better balance between emergency, medical, and surgical referrals could reduce unnecessary emergency admissions and improve the precision of surgical referrals optimizing the use of surgical capacity and healthcare resources in general.
研究因腰椎间盘突出症（LDH）导致新发背痛患者的初次转诊模式及重返工作情况。
基于全国登记的队列研究，纳入2017年从初级医疗转诊至专科医疗且新发背痛、随后被诊断为腰椎间盘突出症（由ICD-10编码DM51X.X定义）的所有18至65岁丹麦居民。使用丹麦国家患者登记系统（DNPR）识别患者，包括直接诊断为LDH的患者以及最初诊断为非特异性腰痛（ICD-10：DM54）且在一年内进展为LDH的患者。人口统计学数据来自丹麦民事登记系统（CRS），工作能力结局通过丹麦边缘化评估登记系统（DREAM）在两年随访期内进行评估。
共有30082人，占18至65岁丹麦人口的0.8%，因新发背痛且最终诊断为LDH从初级医疗转诊至专科医疗。其中，5356人（17.8%）被转诊至急诊科，14628人（48.6%）被转诊至内科，10098人（33.6%）被转诊至外科。然而，各地区的住院率和初次转诊科室差异很大。总体而言，1915人（6.4%）接受了手术。外科科室对既往工作能力高（11%）或中等（14%）的患者手术频率高于工作能力低的患者（4%），尽管后者更常被转诊进行手术评估。超过80%工作能力高或中等的患者在一年内维持工作或重返工作岗位。
在丹麦，因LDH导致新发背痛患者从初级医疗转诊至专科医疗在各地区差异很大，这凸显了需要更标准化的转诊途径。具体而言，确保急诊、内科和外科转诊之间更好的平衡可以减少不必要的急诊入院，并提高手术转诊的精准度，总体上优化手术能力和医疗资源的利用。
