Pediatric emergency medicine trisk 1062 1062
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FIGURE 54.1 Back pain algorithm.
Laboratory studies. Laboratory investigation is not routinely required and
should be directed by the history and physical examination. A complete blood
count, C-reactive protein, and erythrocyte sedimentation rate are indicated if there
is suspicion for infectious, neoplastic, or rheumatologic process. Blood cultures
should be obtained if there is concern for infection. Antinuclear antibody, HLAB27 and rheumatoid factor may help in determination of a rheumatologic process
and a basic metabolic panel, liver tests, lactose dehydrogenase, and uric acid
should be added if neoplasia is a concern. If history and physical examination are
suggestive of other etiologies, additional tests (e.g., urinalysis and urine culture,
pancreatic enzymes, liver tests) may be indicated.
Imaging. Imaging for evaluation of back pain should only be utilized if a
specific disease process is suspected and confirmation on imaging would alter
