• Am J Emerg Med · Apr 2019

    Management of children presenting with low back pain to emergency department.

    • Francesco Saverio Biagiarelli, Simone Piga, Antonino Reale, Pasquale Parisi, Marta Luisa Ciofi Degli Atti, Angelo Gabriele Aulisa, Paolo Schingo, Chiara Ossella, Maria Pia Villa, and Umberto Raucci.
    • Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy. Electronic address: fsaverio.biagiarelli@opbg.net.
    • Am J Emerg Med. 2019 Apr 1; 37 (4): 672-679.

    ObjectiveWe aimed to describe characteristics, etiology and health care use in children with low back pain (LBP) presenting to pediatric emergency department (ED) and to develop an algorithm to design a diagnostic approach.MethodsWe conducted a 7-year cohort study of children admitted to ED with a primary complaint of LBP. They were classified into diagnostic groups: visceral LBP; traumatic LBP; non-visceral/non-traumatic LBP. To identify high-risk factors (red flags) associated with severe prognosis conditions (SPCs), we analyzed the non-visceral/non-traumatic group comparing the SPC children with those children without SPCs.ResultsOur population comprised 140 females (52.6%) and 126 males (47.4%), with a median age of 10.5 years. Eighty children (30.3%) were hospitalized, with an average length of stay of 8.53 ± 9.84 days. SPCs accounted for 28 patients (18.9%) of overall 148 with non-traumatic/non-visceral LBP. In this group, SPCs presented with earlier onset and longer duration of symptoms than non-SPCs. The presence of red flags was more significant in the SPCs group, 28 vs 18; 100% vs 15% (p < 0.001); sensitivity 100%, specificity 85%. Among SPCs, 78.6% were hospitalized vs non-SPC (16.8%) (p < 0.001); within SPC group 2 patients returned because of onset of red flags.ConclusionOur study identified significative high-risk factors (red flags) associated with serious outcomes (SPC group) compared to the non-SPC group, thereby ensuring specific treatment. We developed an algorithm based on previous literature and the findings of our study, which will need to be validated by future prospective research.Copyright © 2018 Elsevier Inc. All rights reserved.

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