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Management of low back pain in Australian emergency departments for culturally and linguistically diverse populations from 2016 to 2021
  1. Qiuzhe Chen1,
  2. Chris G Maher1,
  3. Eileen Rogan2,
  4. Gustavo Machado1
  1. 1 Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 Canterbury Hospital, Campsie, New South Wales, Australia
  1. Correspondence to Qiuzhe Chen, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia; qiuzhe.chen{at}sydney.edu.au

Abstract

Background Disparate care in the ED for minority populations with low back pain is a long-standing issue reported in the USA. Our objective was to compare care delivery for low back pain in Australian EDs between culturally and linguistically diverse (CALD) and non-CALD patients.

Methods This is a retrospective review of medical records of the ED of three public hospitals in Sydney, New South Wales, Australia from January 2016 to October 2021. We included adult patients diagnosed with non-serious low back pain at ED discharge. CALD status was defined by country of birth, preferred language and use of interpreter service. The main outcome measures were ambulance transport, lumbar imaging, opioid administration and hospital admission.

Results Of the 14 642 included presentations, 7656 patients (52.7%) were born overseas, 3695 (25.2%) preferred communicating in a non-English language and 1224 (8.4%) required an interpreter. Patients born overseas were less likely to arrive by ambulance (adjusted OR (aOR) 0.68, 95% CI 0.63 to 0.73) than Australian-born patients. Patients who preferred a non-English language were also less likely to arrive by ambulance (aOR 0.82, 95% CI 0.75 to 0.90), yet more likely to be imaged (aOR 1.12, 95% CI 1.01 to 1.23) or be admitted to hospital (aOR 1.16, 95% CI 1.04 to 1.29) than Native-English-speaking patients. Patients who required an interpreter were more likely to receive imaging (aOR 1.43, 95% CI 1.25 to 1.64) or be admitted (aOR 1.49, 95% CI 1.29 to 1.73) compared with those who communicated independently. CALD patients were generally less likely to receive weak opioids than non-CALD patients (aOR range 0.76–0.87), yet no difference was found in the use of any opioid or strong opioids.

Conclusion Patients with low back pain from a CALD background, especially those lacking English proficiency, are significantly more likely to be imaged and admitted in Australian EDs. Future interventions improving the quality of ED care for low back pain should give special consideration to CALD patients.

  • emergency departments
  • pain management
  • musculoskeletal system

Data availability statement

No data are available. Not applicable (no additional data available).

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Data availability statement

No data are available. Not applicable (no additional data available).

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Footnotes

  • Handling editor Mary Dawood

  • Twitter @gustavocmachado

  • Contributors QC: study concept and design, analysis and interpretation of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical expertise. CGM: study concept and design, interpretation of the data, critical revision of the manuscript for important intellectual content. ER: interpretation of the data, critical revision of the manuscript for important intellectual content. GM: study concept and design, acquisition of the data, interpretation of the data, critical revision of the manuscript for important intellectual content. QC is the guarantor of the paper. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.