Background Among people over 65 years old, many circumstances increase the frequency and intensity of back pain including osteoarthritis, less muscle mass and kyphosis. Acute vertebral fracture (VF) is also a cause of intense spine pain and a relevant cause of consultation due to its locomotive impairment and need of potent pharmacological analgesia.
Objectives To compare the frequency of healthcare demand and intensity of analgesic treatment of patients with lumbar or dorsal pain according to the existence or not of a vertebral fracture excluding the acute event.
Methods A retrospective comparative study was conducted. Registries of patients who consulted in our A&E department by lumbar or dorsal pain, older than 65 years old from November 2013 to November 2015 were identified and grouped according to the presence or absence of a known VF. Records of patients who were diagnosed by the first time of vertebral fracture during the medical attention were excluded. Main outcome variables were number of consultations/year and type of treatment according to the WHO pain ladder.
Results The inclusion criteria were achieved in 1528 registries. Among them, 76 registries were incomplete or unavailable. Of the remaining 1452 registries, 168 (11.5%) presented a previously documented vertebral fracture (PDVF) and the remaining did not (nVF). Average age in the PDVF and nVF group was 75.9 SD 3.3 and 73.6 SD 4.2 years old, respectively (P=0.0001). Average number of consultations was 1.58 SD 0.23 consultations/year in PDVF group and 1.02 SD 0.11 consultations/year in nVF group (95%CI of difference 0.5391–0.5809; P=0.0001; T Student's test). Among patients with PDVF, MD group had an average of 1.60 SD 0.26 consultations/year and CRVF group had an average of 1.60 SD 0.32 (P=0.29). The odds ratio of to require a further consultation within a month of first assessment was 2.24 when PDVF group was compared with nVF group (CI95% 1.54–3.26; P<0.0001). At discharge, 42 (25.0%) patients of PDVF group and 652 (50.7%) of nVF group were sent to primary care units and 98 (58.3%) patients of PDVF group and 210 (16.3%) of nVF group were sent to secondary care units (P=0.0001 for both comparison, Fisher's exact test). The odds ratio of be discharged without need of further follow up was 0.40 when compared PDVF and nVF group (CI95% 0.26–0.62; P<0.0001). 53.5% of PDVF patients and 23.4% of nVF patients were treated at discharge with 2° scale WHO-pain ladder drugs (P=0.0001). 29.1% of PDVF group and 23.4% of nVF group were treated with 3rd scale WHO-pain ladder drugs (P=0.0001). The odds ratio of be treated with major opiods at discharge was 78.02 when compared PDVF with nVF group (CI95% 38.57–161.86; P<0.0001). Among patients with PDVF, 21.3% of patients of the MD group and 41.5% of patients of the CRVF were treated with drugs of the 3rd scale WHO-pain ladder (OR 2.61; 95%CI 1.32–5.17, P=0.0057)
Conclusions Patients with non-acute vertebral fractures have a higher index of urgent consultations per year, are more probably to be treated with major opiods and generates a higher burden of primary or secondary care appointments. As far as we know, this is the very first study which measures the impact of VF in an urgency environment.
Disclosure of Interest None declared