Biagiarelli MS, et al. - Children with low back pain (LBP) presenting to pediatric emergency departments (EDs) were investigated regarding their characteristics, etiology and health care use, and to help in developing an algorithm to design a diagnostic approach. Compared to the non-severe prognosis conditions (SPCs) group, significative high-risk factors (red flags) associated with serious outcomes in the SPCs group were noted, thereby ensuring specific treatment. Based on previous literature and the findings of this study they developed an algorithm, which requires further validation.

Methods

• A 7-year cohort study was performed of children admitted to ED with a primary complaint of LBP.
• Classification of children into following diagnostic groups was performed: visceral LBP, traumatic LBP, non-visceral/non-traumatic LBP.
• Analysis of the non-visceral/non-traumatic group comparing the SPC children with those children without SPCs was performed to determine high-risk factors (red flags) associated with SPCs.

Results

• In this study, 140 females (52.6%) and 126 males (47.4%) comprised the study population (median age: 10.5 years).
• Hospitalization of 80 children (30.3%) was observed, with an average length of stay of 8.53 ± 9.84 days.
• Of overall 148 patients with non-traumatic/non-visceral LBP, 28 patients (18.9%) had SPCs.
• In this group, compared to non-SPCs, SPCs reported earlier onset and longer duration of symptoms.
• In the SPCs group, the presence of red flags was more significant, 28 vs 18; 100% vs 15% (p < 0.001); sensitivity 100%, specificity 85%.
• Hospitalization was reported for 78.6% among SPCs vs non-SPC (16.8%) (p < 0.001); within the SPC group, 2 patients returned because of onset of red flags.