Back pain “red flags”: which are most predictive of serious pathology in the Emergency Department?

Shaw, Bridget; Kinsella, Rita; Walby, Andrew; Cowan, S. T.

doi:10.1007/s00586-020-06452-1

Cited by 18 publications

(39 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…NSLBP is under‐diagnosed, over‐investigated, over‐medicalised and insufficient exercise prescription is provided. NSLBP represents 99% of low back pain presentations to general practice and 74% of low back pain presentations to the ED 16,17 . NSLBP can be treated the same way as other musculoskeletal pain.…”

Section: Non‐specific Low Back Painmentioning

confidence: 99%

“…Combinations of red flags and the overall history are likely of much greater value. Further research is needed to determine the clinical utility of red flags 16,17 …”

Section: Judicious Imagingmentioning

confidence: 99%

“…NSLBP represents 99% of low back pain presentations to general practice and 74% of low back pain presentations to the ED. 16,17 NSLBP can be treated the same way as other musculoskeletal pain. That is, RICE is dead and PEACE and LOVE is in.…”

Section: Non-specific Low Back Painmentioning

confidence: 99%

“…Further research is needed to determine the clinical utility of red flags. 16,17 Role for passive interventions?…”

Section: Judicious Imagingmentioning

confidence: 99%

See 3 more Smart Citations

Including exercise prescription in the management of non‐specific low back pain

Osborne

Burt

2022

Emerg Medicine Australasia

View full text Add to dashboard Cite

Section: Non‐specific Low Back Painmentioning

confidence: 99%

“…Combinations of red flags and the overall history are likely of much greater value. Further research is needed to determine the clinical utility of red flags 16,17 …”

Section: Judicious Imagingmentioning

confidence: 99%

Section: Non-specific Low Back Painmentioning

confidence: 99%

“…Further research is needed to determine the clinical utility of red flags. 16,17 Role for passive interventions?…”

Section: Judicious Imagingmentioning

confidence: 99%

See 2 more Smart Citations

Including exercise prescription in the management of non‐specific low back pain

Osborne

Burt

2022

Emerg Medicine Australasia

View full text Add to dashboard Cite

“…Clinical guidelines commonly recommend the use of red flag questions in the assessment of LBP when deciding to refer for imaging to rule out serious pathology. Despite this common recommendation, there is little evidence supporting their diagnostic accuracy [9,21]; however, their presence or absence continues to be used as indicators for imaging [4]. For example, in assessing use of spinal imaging and adherence to guidelines, varying definitions involving red flags have been used, ranging from the absence of red flags to the presence of one or more and to only red flags attributed to serious pathology [2,4,8,9,22].…”

Section: Introductionmentioning

confidence: 99%

Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study

et al. 2022

View full text Add to dashboard Cite

Background: Diagnostic imaging is useful for assessing low back pain (LBP) when a clinician suspects a specific underlying pathology. Evidence-based imaging guidelines assist clinicians in appropriately determining the need for imaging when assessing LBP. A previous study reported high adherence to three clinical guidelines, with utilization rate of 12.3% in imaging of LBP patients attending a chiropractic teaching clinic. A new imaging guideline for spinal disorders has been published and used in teaching. Thus, the aims of our study were to assess the adherence to the new guideline and X-ray utilization in new episodes of LBP. Methods:We conducted a historical clinical cohort study using patient electronic health record audits at seven teaching clinics over a period of 20 months. Records of patients who were at least 18 years of age, presented with a new onset of LBP, and consented to data collection were included. Abstracted data included patient demographics, the number and type of red flags, and the decision to image. Rate of guideline adherence (proportion of those not recommended for imaging, given no red flags) and rate of image utilization were descriptively analyzed. Results:We included 498 patients in this study. At least 81% of included patients had one or more red flags reported. The most commonly reported individual red flag was age ≥ 50 (43.8%) followed by pain at rest (15.7%). In those referred for imaging, age ≥ 50 (93.3%) was the most frequently reported red flag. No red flag(s) were identified in 93 patient records, and none were referred for imaging of their LBP, yielding an adherence rate of 100% (95% CI 96, 100%). A total of 17 of 498 patients were recommended for imaging for their low back pain, resulting in an imaging utilization rate of 3.4% (95% CI 1.8, 5.0%). Conclusion:The imaging utilization rate was 3.4%, lower than 12.3% previously reported at a chiropractic teaching clinic. None without red flags were referred for imaging, yielding a 100%, adherence rate to current LBP imaging guidelines. Future research should consider currency of guideline, accuracy of red flags and factors influencing clinicians' decision, when assessing imaging adherence rates.

show abstract