INTRODUCTION: The virtual hospital model of care has been proposed as a clinical pathway for musculoskeletal back pain. Understanding the prevalence of serious pathology in patients who are admitted with a provisional diagnosis of non-serious back pain is essential in determining the feasibility and safety of a virtual hospital model care as an alternative to inpatient admission.
AIM: To determine the proportion of patients admitted to hospital for back pain, that have non-serious back pain, serious spinal, or serious other pathology as their final diagnosis.
METHODS: Electronic medical record data between 2016-2020, from three Emergency Departments (ED) in Sydney, Australia were used to identify inpatient admissions. SNOMED-CT-AU diagnostic codes were used to select ED patients aged 18 and older with an admitting diagnosis related to non-serious back pain. The inpatient discharge diagnosis was determined from the primary ICD-10-AM codes by two independent clinician researchers.
RESULTS: Over half (57%) of the admissions from ED with a provisional diagnosis of nonserious back pain had an equivalent discharge diagnosis and so are likely to be suitable for a virtual hospital model of care. However, a significant proportion of patients admitted with nonserious back pain were subsequently diagnosed with a specific pathology likely unsuitable for virtual care; 14.2% with a serious spinal pathology and 23.9% with a serious pathology beyond the lumbar spine. The most common serious spinal pathologies were fracture (8.7%) and infection (2.1%), and the most common serious pathologies beyond the spine were pathological fracture (7.3%) and infection (4.3%). In those aged ≥ 65, serious spinal pathology had a prevalence rate of 16.2%, compared to 10.6% in those under 65. Pathologies beyond the lumbar spine were also more prevalent at 26.6% in those aged ≥ 65, compared to 18.9% of those younger than 65.
CONCLUSION: A challenge for implementing virtual care in this setting is screening for patients with serious pathology. Protocols need to be developed to reduce the risk of patients being admitted to virtual hospital with serious pathology as the cause of their back pain.