A presentation of nontraumautic back pain in the emergency department rarely leads to paralysis or death. But how do you find the case that does?

Rahul Bhat, MD, FACEP, of MedStar Health in Washington, D.C., aims to answer that question during his session, “Nontraumatic Back Pain: Reasons Why It Should Tighten Your Sphincter.”

“It’s important to identify the key risk factors based on history and physical exam that would prompt imaging in the emergency department to evaluate for a neurosurgical emergency,” Dr. Bhat said. “For example, risk factors such as IV drug use or diabetes or dialysis patients might give a physician pause to order additional testing when a patient complains of back pain.

“If they have one or more of these risk factors, then you really do need to do more of a workup for them,” Dr. Bhat said. “But if they have no risk factors with a normal physical exam, then imaging is rarely indicated in the emergency department.”

“It’s important to identify the key risk factors based on history and physical exam that would prompt imaging in the emergency department ”
—Dr. Bhat

Dr. Bhat suggests using a checklist to obtain all high-risk history and exam findings and avoid a haphazard approach. He warns that not systematically checking for risk factors may work out nearly all of the time, but it only takes one mistake.

“It is something you can get lulled into a sense of security because it is so uncommon that something bad actually is there,” Dr. Bhat said. “But you’ll miss it if you don’t have a vigilant approach to this.”

Dr. Rahul Bhat, MD, FACEP

Nontraumatic Back Pain: Reasons why it Should Tighten Your Sphincter
Sunday, Oct. 29
12:30-12:55 p.m.
WCC, Ballroom B