Lumbar spine x-rays: A multihospital study

Patrick, John D.; Doris, Peter E.; Mills, Melissa; Friedman, Joel; Johnston, Charles E.

doi:10.1016/s0196-0644(83)80378-3

Cited by 11 publications

(9 citation statements)

References 9 publications

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“…For each included study, details on the design, setting, population, reference standard, index tests used, and definition of the target condition are provided in tables B and C in the appendix. Most studies (eight) were set in primary care,7 25 26 27 28 29 30 31 two in secondary care,32 33 and the four remaining in tertiary care (three in emergency departments34 35 36 and one in a spinal surgical unit37). Three studies investigated red flags for both fracture and malignancy 7…”

Section: Resultsmentioning

confidence: 99%

“…Prevalence varied among studies for both fracture (primary care: median 3.6%, interquartile range 1.8-4.3%; secondary/tertiary care: 6.5%, 2.9-9.1%), and malignancy (primary care: 0.2%, 0.1-0.7%; secondary care: one study 7%; tertiary care: two studies 1.5% and 5.9%). Point prevalence used to calculate post-test probability in this review was determined by extracting prevalence from a reduced set of methodologically robust studies for fracture7 33 35 and cancer,7 27 and by considering a value that could be readily applied in the clinical setting (fracture: 1% for primary care, 5% for secondary and tertiary care; malignancy: 0.5% for primary care, 1.5% for secondary and tertiary care).…”

Section: Resultsmentioning

confidence: 99%

“…The reviews identified 29 red flags to screen for fracture7 25 26 27 33 34 35 36 and 24 to screen for malignancy,7 27 28 29 30 31 32 34 37 with 13 (25%) evaluated in more than one study. Only six studies reported on the accuracy of combinations of red flags,7 25 33 35 36 37 and few studies provided precise definitions for each red flag. Figures 2-5 show the positive and negative likelihood ratios and associated post-test probabilities for each red flag.…”

Section: Resultsmentioning

confidence: 99%

“…†Minor trauma: in elderly women with osteoporosis (Scavone26). ‡Trauma: history of direct trauma (Gibson36); history of trauma (Patrick,35 Reinus34). §History of osteoporosis not evaluated by any included study…”

Section: Resultsmentioning

confidence: 99%

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Red flags to screen for malignancy and fracture in patients with low back pain: systematic review

Downie

Williams

Henschke

et al. 2013

BMJ

249

143

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Objective To review the evidence on diagnostic accuracy of red flag signs and symptoms to screen for fracture or malignancy in patients presenting with low back pain to primary, secondary, or tertiary care. Design Systematic review.Data sources Medline, OldMedline, Embase, and CINAHL from earliest available up to 1 October 2013.Inclusion criteria Primary diagnostic studies comparing red flags for fracture or malignancy to an acceptable reference standard, published in any language.Review methods Assessment of study quality and extraction of data was conducted by three independent assessors. Diagnostic accuracy statistics and post-test probabilities were generated for each red flag. ResultsWe included 14 studies (eight from primary care, two from secondary care, four from tertiary care) evaluating 53 red flags; only five studies evaluated combinations of red flags. Pooling of data was not possible because of index test heterogeneity. Many red flags in current guidelines provide virtually no change in probability of fracture or malignancy or have untested diagnostic accuracy. The red flags with the highest post-test probability for detection of fracture were older age (9%, 95% confidence interval 3% to 25%), prolonged use of corticosteroid drugs (33%, 10% to 67%), severe trauma (11%, 8% to 16%), and presence of a contusion or abrasion (62%, 49% to 74%). Probability of spinal fracture was higher when multiple red flags were present (90%, 34% to 99%). The red flag with the highest post-test probability for detection of spinal malignancy was history of malignancy (33%, 22% to 46%).Conclusions While several red flags are endorsed in guidelines to screen for fracture or malignancy, only a small subset of these have evidence that they are indeed informative. These findings suggest a need for revision of many current guidelines.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Red flags to screen for malignancy and fracture in patients with low back pain: systematic review

Downie

Williams

Henschke

et al. 2013

BMJ

249

143

View full text Add to dashboard Cite

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“…The overall incidence of spinal infection in this study was 6.6 per 100,000 p-y, which is higher than reported rates for vertebral osteomyelitis or pyogenic spondylodiscitis in Europe [62,64−66]. Vertebral fracture is relatively common with a prevalence of vertebral fracture internationally is 2.2%−2.6% in secondary care [1,19] and 6.5%−7.2% in tertiary care [18,20]. A''s expected, our study found that the incidence of fracture increased with older age, and interestingly, all fractures in the under 35-year-old age group were male and were traumatic, which may reflect the commonly held belief that young males have increased risk-taking behavior and involvement in adventure sport.…”

Section: Discussioncontrasting

confidence: 49%

Clinical prevalence and population incidence of serious pathologies among patients undergoing magnetic resonance imaging for low back pain

2020

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BACKGROUND: In rare cases low back pain may be caused by underlying serious pathology such as fracture, malignancy, cauda equina syndrome, or spinal infection. The lack of evidence regarding either the clinical prevalence or population incidence of serious pathologies in the lumbar spine makes it difficult for clinicians to adequately assess a patient's risk of serious pathology. PURPOSE: To determine the prevalence of serious pathologies in patients with low back pain who have been referred for a lumbar magnetic resonance imaging (MRI) by a specialist in a private secondary care or public tertiary care setting. The incidence of these serious pathologies in the geographic region of South Auckland, New Zealand was also investigated. STUDY DESIGN: Retrospective, observational cohort study. PATIENT SAMPLE: Consecutive patients referred for lumbar MRI over a 10-month period (1st of October 2013−31st of July 2014). METHOD: Data from all eligible MRI reports was analyzed and any serious pathologies were identified and recorded. Prevalence (along with 95% confidence intervals) was calculated as a percentage of the study population. Prevalence specific to private secondary care and public tertiary care settings was also calculated and prevalence rate ratios were determined to allow comparison between settings. Incidence in the geographic region of South Auckland, New Zealand, was determined using data collected from participants recruited from the regional public hospital. Population incidence with respect to age, gender, and ethnicity for each target condition was calculated and incidence rate ratios were computed to compare groups. RESULTS: A total of 2,383 participants referred for lumbar MRI scans were included in this study. Prevalence was significantly higher in the public tertiary care setting than in the private secondary care setting for all pathologies investigated in this study. Pathology specific prevalence in secondary care vs tertiary care settings was: malignancy, 0.3%, 4.4% (p<.001); fracture 2.2%, 6.7% (p<.001); cauda equina compression 0.6%, 2.3% (p=.001); infection 0.1%, 3.4% (p<.001). The combined prevalence in secondary care was 3.2% and in tertiary care 14.8% (p<.001). Pathology specific total incidence was: fracture, 13 per 100,000 person-years (p-y); malignancy 8.5 per 100,000 p-y; cauda equina compression 4.4 per 100,000 p-y; spinal infection 6.6 per 100,000 p-y.

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Red flags to screen for vertebral fracture in patients presenting with low-back pain

Williams

Henschke

Maher

et al. 2013

Cochrane Database of Systematic Reviews

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Lumbar spine x-rays: A multihospital study

Cited by 11 publications

References 9 publications

Red flags to screen for malignancy and fracture in patients with low back pain: systematic review

Red flags to screen for malignancy and fracture in patients with low back pain: systematic review

Clinical prevalence and population incidence of serious pathologies among patients undergoing magnetic resonance imaging for low back pain

Red flags to screen for vertebral fracture in patients presenting with low-back pain

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