(230) Few individuals at high risk of persistent musculoskeletal pain after motor vehicle collision receive early psychological or physiotherapy intervention

More than four million patients present to U.S. Emergency Departments (EDs) each year after motor vehicle collision (MVC). Over 90% of these individuals have acute musculoskeletal pain (MSP), and, while less than 5% have a fracture or require hospital admission, 20-30% transition to persistent MSP. Individuals presenting to the ED with acute MSP after MVC do not receive risk-stratified care, however in other settings providing stratified physiotherapy and psychological interventions for acute MSP has been shown to improve outcomes and reduce costs.1 The goal of this study was to characterize health resource utilization according to persistent axial MSP (PAMSP) risk among individuals presenting to the ED after MVC. Data for this analysis was obtained from a large prospective cohort of 948 European Americans who presented to the ED after MVC and were discharged home after evaluation. Participants were categorized as being at low, medium, or high risk of PAMSP using data obtained at the baseline ED visit and a previously developed tool. Pain outcomes and medication and health service use were assessed at six week follow-up (obtained in 859/948 (91%)), PAMSP at six weeks was present in 63 (24%), 134 (50%), and 206 (78%) of those categorized from ED data as being at low, medium, and high risk of PAMSP, respectively. At six week follow-up, only 17 (6%) of those at high risk of PAMSP had seen a mental health provider and only 123 (46%) had received any sort of manual therapy. Use of opioid sparing agents was very low (e.g., gabapentin (16 [4%]) and SNRIs (7 [2%]). These data indicate that health services utilization among individuals with acute MSP after MVC is poorly stratified. Further studies are needed to determine if stratified interventions could improve outcomes and/or reduce costs. (1. Hill et al., Lancet, 2011.) Supported by NIAMS R01AR056328.