THU0469 Comparison of Dorsal and Lumbar Pain in Patients with and without Non-Acute Vertebral Fractures in Terms of Therapeutic Approach and Urgent Care Burden
Authors: C.A. Guillen-Astete, A. Boteanu
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> 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. <h3>Objectives</h3> 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. <h3>Methods</h3> A retrospective comparative study was conducted. Registries of patients who consulted in our A&amp;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. <h3>Results</h3> 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 (<i>P</i>=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; <i>P</i>=0.0001; T Student9s 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 (<i>P</i>=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; <i>P</i>&lt;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 (<i>P</i>=0.0001 for both comparison, Fisher9s 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; <i>P</i>&lt;0.0001). 53.5% of PDVF patients and 23.4% of nVF patients were treated at discharge with 2° scale WHO-pain ladder drugs (<i>P</i>=0.0001). 29.1% of PDVF group and 23.4% of nVF group were treated with 3rd scale WHO-pain ladder drugs (<i>P</i>=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; <i>P</i>&lt;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, <i>P</i>=0.0057) <h3>Conclusions</h3> 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. <h3>Disclosure of Interest</h3> None declared