Risk Factors for Underlying Pathology in LBP Patients.
The July issue of the Journal of Emergency Medicine had an article of special interest to chiropractors. It had to do with the risk factors for low back pain.
The study was designed as a review of records on 329 patients, ages 16 and older who presented in the E.R. with non traumatic LBP. The authors excluded patients presenting with obvious kidney pain (renal colic) and/or a prior history of kidney stones.
They looked at the outcomes on the patients and compared them with 56 possible “predictor variables” to determine if identifiable risk factors could be determined for serious, underlying pathology. Of the 329 patients, 6.7% (N=22) were ultimately shown to have serious underlying pathology. Example of the underlying problems encountered included compression fractures, malignancies, disc prolapses requiring surgery, retroperitoneal bleeds, osteomyelitis, epidural abscess, cauda equina syndroms, and leaking aortic aneurysms. One patient died.
The high risk factors which were identified were:
- Anticoagulant use.
- Decreased sensation on physical examination.
- Pain at night.
- Pain that persists despite appropriate treatment.
A simple awareness of these four basic risk factors appears to provide a very high rate of predictability in detecting patients who are likely to require additional medical attention.
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