Back pain in children who present to the emergency department

The purpose of this study was to identify the causes and epidemiology of back pain in children who present to the emergency department. All children who presented to an urban pediatric emergency department (ED) during a 1-year period with the chief complaint of back pain were examined and evaluated with a uniform questionnaire, This was completed at the time of the ED visit in 48%, and within 48 hours in 52%, During a 1-year period, 225 children with a complaint of back pain were evaluated. The mean age was 11.9 +/-4 years and 60% were female. Onset was acute (less than or equal to 2 days) in 59%, and chronic (greater than or equal to 4 weeks) in only 11.6%, Pain awakened children from sleep in 47%, and caused 52% to miss school or work, The most common diagnoses were direct trauma (25%), muscle strain (24%), sickle cell crises (13%), idiopathic (13%), urinary tract infection (5%), and viral syndrome (4%), Radiographs of the back were rarely helpful. About 5% required hospital admission; one half of these were attributed to sickle cell crises. We conclude that back pain is an uncommon reason for children to present to an emergency department. When present, pediatric back pain is most often musculoskeletal, associated with an acute infectious illness or a traumatic event. Although the etiology is rarely serious, back pain often affects the daily activities of symptomatic children.