Global prevalence of serious pathologies in people with low back pain seeking care in different complexity healthcare levels: a systematic review with meta-analysis and meta-regression

Abstract

Low back pain is one of the main causes of years lived with disability and work absenteeism, which imposes an enormous burden on health care systems worldwide. Individual estimates showed that 1 to 4% of low back pain cases are attributable to serious spinal pathologies such as fractures, infections, tumors, and cauda equine syndrome. Despite conflicting diagnostic accuracy, red flags consist of signs and symptoms that could help clinicians identify serious spinal pathologies in patients with low back pain. Health professionals that work at different health care levels (for example, emergency departments, primary care, secondary or tertiary care) should have readily available specific evidence-based protocols for the assessment and treatment of these patients. However, no study has estimated the prevalence of serious spine pathologies considering possible variations due to the geographic location and the healthcare level that patients sought for care. Objectives: to estimate the global prevalence of serious spine pathologies in the people seeking care for low back pain as well as if this estimate differs considering health care levels. The secondary objective is to investigate whether the prevalence of serious pathologies differs when comparing studies using objective (e.g., imaging) or subjective (e.g., clinical tests) methods to detect serious spinal pathologies. Methods: literature searches for this systematic review will be performed using the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS), and Scientific Electronic Library Online (SciELO). The search strategy will be conducted combining terms related to serious spinal pathologies, low back pain, and prevalence. The following information will be extracted from included studies using a standardized form: author; year; country; sample size; study design; sex; age group; healthcare level; serious spine pathology (cauda equina syndrome, fracture, malignancy, and infection), and presence of red flags. The meta-analysis will be calculated to obtain the pooled prevalence of serious spine pathologies in people with low back pain and a meta-regression analysis will be calculated to investigate whether this prevalence differs considering the different healthcare levels. (AU)