E013 Looking back at back pain: how well do our referrals measure up to available criteria?

Abstract

Abstract Background/Aims According to the Global Burden of Disease Study 2021, low back pain remains the leading cause of years lived with disability (YLDs) globally affecting about 619 million people as of 2020. Inflammatory back pain affects fewer patients but remains an important referral indication. A previous audit from the early back pain clinic of cases seen between 2015-16 at the Royal National Hospital for Rheumatic Diseases, Bath, identified an axial spondyloarthritis (AxSpA) diagnosis in 21% of patients of whom, two thirds were HLAB27 positive. This follow-up audit aimed to evaluate for interval change in axSpA prevalence and assess the referrals against NICE and ASAS criteria respectively. While the NICE referral guidance is largely clinical, ASAS incorporates extra musculoskeletal manifestations and investigations. Methods We reviewed 100 of the 271 early back pain clinic referrals received between July 2022-23. The completed referral proforma was evaluated against the NICE and ASAS criteria respectively. Electronic medical records and clinic letters of patients were also reviewed including demographics, baseline investigations and imaging. Results The patients were 54% male with an average age of 38.7 ± 13.7years. An axSpA diagnosis was made in 19 patients (19%) of which 12 were HLAB27 positive (63.1%). The median symptom duration was 24 months (6-72) with an appointment delay of 128 days (36-182). Discharge rate was 35% after the first appointment. Overall, 62% of referrals satisfied NICE criteria compared to 71% for ASAS. This was after excluding 21 referrals which did not satisfy the ASAS entry criterion of symptoms > 3months in patients <45 years. Among our cohort, sensitivities were 68.4% for NICE and 73.7% for ASAS while specificities were 39.5% for NICE and 29.6% for ASAS. Three patients all above 45 years with a normal CRP met neither criteria, but were diagnosed with axSpA after MRI while one patient who satisfied both criteria turned out to have lung cancer with bony metastases. Conclusion There has been minimal interval change in AxSpA prevalence from our referrals between 2015-23. The ASAS criteria was easier to satisfy and can serve as an alternative referral indication for patients who do not meet NICE criteria. Both criteria are still very useful in terms of ensuring the quality of referrals received. Improvements in the referral pathway are being planned to reduce primary and secondary care delays thus enhancing earlier diagnosis and treatment. Disclosure A. Akpabio: None. M. Camillieri: None. T. Williams: None. R. Sengupta: None.