WASHINGTON, D.C.—Most emergency physicians aren’t overly worried about that 62-year-old patient presenting with back pain once they find out the person just started Pilates last week and has no other underlying medical issues. But what about the same patient who presents back pain and a fever in their dialysis treatment on the same day? Should that patient get a more detailed work-up? Imaging? High-end imaging?
Rahul Bhat, MD, FACEP, of MedStar Health in Washington, D.C., said there is no easy answer to non-traumatic back pain, but being in the mindset to at least ask questions about it—even though 95 percent of cases are routine—will help emergency physicians ensure they catch relatively rare diagnoses.
“If you play not to lose, then you have to really make sure you pick up that last 5 percent,” Dr. Bhat said after his rapid-fire session, ““Non-traumatic Back Pain: Reasons Why It Should Tighten Your Sphincter.”“And if you don’t, at some point once every year or two, you’re going to have a dangerous diagnosis that you miss.”
Dr. Bhat said emergency physicians should pay attention to five main causes of spinal cord compression: infections, hematomas, fractures, tumors, and disc issues. Asking more targeted questions about “red flag” epidemiological risk factors and symptoms can dramatically increase the chances of catching a diagnosis that might otherwise be missed.
But, Dr. Bhat emphasizes, those questions should not be left to rote memorization and a physician attempting to remember them for each patient. Instead, emergency physicians should commit the questions to a checklist or a templated note that ensures all of the necessary questions are asked.
“If you have to memorize them, I don’t think anyone is actually going to stick with it,”Dr. Bhat said. “But if you have it templated, it probably takes three to five minutes to ask all these questions. And [it’s] worth doing it because if you miss it, you’re going to be paying a lot more time down the road.”
While presentations of non-traumautic back pain in emergency departments nationwide rarely lead to paralysis or death, Dr. Bhat said cases that could have more significant outcomes will become a larger part of emergency physicians’ duties over time.
“The rate of cord compression that we’re going to see is just going to go up,” he said. “Because of IV drug abuse, additional medical problems, [an] older population. More people are going to experience this.”