A review of accident and emergency attendances for non-traumatic musculo-skeletal complaints

As there have been no previous studies, we undertook a systematic review to determine the number and nature of musculo-skeletal complaints presenting to casualty departments, review the appropriateness of treatment and referrals to other departments and also to identify potential problem areas so as to address these. Over the review period of 40 non-consecutive days, the total attendance was 2863 patients of which 85 (2.97%) presented with musculo-skeletal complaints. The majority (691) were in the age group of 20–59 years. Most complaints were in the back (26), neck (11), chest (10), shoulder (8), knee (8). Main complaints were pain (78), tenderness (10), swelling (9), stiffness (9), reduced movements (8) or a combination thereof; the rest were miscellaneous, e.g. pyrexia, headache and paraesthesia. The majority had a duration of symptoms from 1 to 7 days. Investigations at the casualty department were radiographs (29), full blood count (6), biochemistry (6), erythrocyte sedimentation rate (ESR) (1), blood culture (1), electrocardiogram (ECG) (7), and joint aspiration (2). Advice was sought from orthopaedic (2), rheumatology or general medicine (0), or other departments (2). Casualty diagnoses were mainly non-inflammatory conditions. Treatment given included analgesics/non-steroidal inflammatory drugs (NSAIDs) (44), splints and slings (5), Tubigrip (6), and collars (5). Only two patients (2.4%) were admitted. We were pleasantly surprised to note very small numbers of patients with inflammatory conditions, possibly indicating previous optimal management in our locality. A surprising finding was the lack of any attendance with gout. More direct referrals to orthopaedic or rheumatology departments would be appropriate in some instances. As a result of this review, we decided to offer short courses on musculo-skeletal medicine for new casualty officers and we have also produced guidelines/algorithm for management which would be equally useful for general practitioners.