Abstract
Introduction
Back pain is a common presentation in general practice and a significant cause of morbidity in the elderly population. While the majority of cases are secondary to chronic degenerative changes, a number of sinister pathologies may prompt referral beyond primary care. This project assesses whether RADAR is the appropriate service to refer elderly patients with back pain through analysis of patient demographics and NICE guidance.
Methods
A total of 373 RADAR appointments from October 2020 until April 2022 were screened for record of “Back”/”Spinal” pain. Of the 104 appointments found, 41 patients were selected for further analysis with back pain as a significant presenting complaint. Data categories collected on each patient included comorbidity scoring using cumulative illness rating score (CIRS-G), NICE red flag symptoms, diagnoses, referral locations and waiting times between referral and visit.
Results
Patients had multiple comorbidities with a mean average of 6 organ systems affected by disease in addition to their back pain. Median average waiting times from referral to clinic was 2 days. All patients were over 50, satisfying NICE criteria for at least one cancer red flag. 65.8% also contained other NICE cancer red flags, with 14.6% of patients presenting with a combination of cancer and neurological red flag symptoms. Diagnoses included degenerative spinal disease (24.3%), vertebral fracture (22.0%), spinal stenosis (12.2%) and tumours (9.7%). 78% of patients avoided admission.
Conclusion
RADAR addresses elderly, comorbid patients with worrying yet cryptic sinister presentations in a holistic manner. Patients are seen far more quickly than a standard 2 week wait referral enabling rapid diagnosis and management, with the majority of patients being managed as an outpatient. It also enables complex older patients to be seen who do not fit urgent criteria for other existing back pain pathways.