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Chiropractic Litterature Review

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In the News - July 23, 2014

Risk factors for underlying pathology in LBP patients.

The July issue of the Journal of Emergency Medicine has a new article of interest to every D.C. 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:

  1. Anticoagulant use.
  2. Decreased sensation on physical examination.
  3. Pain at night.
  4. 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.

Author: Mark R. Payne DC

Reference: Thiruganasambandamoorthy V1, Turko E2, Ansell D3, Vaidyanathan A4, Wells GA5, Stiell IG1. Risk factors for serious underlying pathology in adult emergency department nontraumatic low back pain patients. J Emerg Med. 2014 Jul;47(1):1-11. doi: 10.1016/j.jemermed.2013.08.140. Epub 2014 Apr 13.

Link To Abstract: http://www.ncbi.nlm.nih.gov/pubmed/24725822

Acknowledgment: Special thanks to David Graber DC, DACBSP, (Mountain Lakes NJ) for suggesting this article.

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