WHAT ARE THE RED FLAGS IN A PATIENT PRESENTING WITH LOW BACK ACHE ?
A 2 DEFINITION
1 Clinical findings that increase the level of suspicion that there is a serious medical condition presenting as common, nonserious, musculoskeletal conditions, are commonly described as red flags.
2 Red flags are features from a patients subjective and objective assessment which are thought to put them at a higher risk of serious pathology and warrant referral for further diagnostic testing ( vv imp )
A ) They often highlight non-mechanical conditions or pathologies of visceral origin and can be contraindications to many treatments.
3 Although red flags have a valid role to play in assessment and diagnosis they should also be used with caution.
4 Some guidelines contain no information on diagnostic accuracy for individual red flags, so it is the responsibility of individual practitioners to make themselves aware of these.
5 Other guidelines even recommend immediate referral to imaging if any red flag is present, which could lead to many unnecessary referrals if clinicians did not clinically reason their referral
6 The presence of certain signs, termed red flags, indicate the need for further testing to look for more serious underlying problems, which may require immediate or specific treatment
7 The presence of a red flag does not mean that there is a significant problem. It is only suggestive, and most people with red flags have no serious underlying problem.
8 Imaging is indicated when there are red flags, ongoing neurological symptoms that do not resolve, or ongoing or worsening pain. In particular, early use of imaging (either MRI or CT) is recommended for suspected cancer, infection, or cauda equina syndrome
9 Tells us about prognosis of a given condition *
FOLLOWING ARE THE RED FLAGS ACCORDING TO VARIOUS CAUSES OF LOW BACK ACHE
1 CANCER RELATED
A ) History of cancer
B ) Unexplained weight loss >10 kg within 6 months
C ) Age over 50 years or under 18 years old ( ** )
D ) Failure to improve with therapy
E ) Pain persists for more than 4 to 6 weeks
F ) Night pain or pain at rest
2 INFECTION RELATED
A )Persistent fever (Temperature over 100.4
B ) History of intravenous Drug Abuse
C ) Severe Pain
D ) Lumbar Spine surgery within the last year
E ) Recent Bacterial Infection
F ) Urinary Tract Infection or Pyelonephritis
G ) Cellulitis
H ) PneumoniaWound (e.g. Decubitus Ulcer) in spine region
I ) Immunocompromised states
J ) Systemic Corticosteroids
K ) Organ transplant
L ) Diabetes Mellitus
M ) Human Immunodeficiency Virus (HIV)
N ) Rest pain
3 CAUDA EQUINA SYNDROME RELATED
A ) Urinary Incontinence or retention
B ) Saddle anesthesia
C ) Anal sphincter tone decreased or Fecal Incontinence
D ) Bilateral lower extremity weakness or numbness
E ) Progressive neurologic deficit
F ) Major motor weakness
G ) Major sensory deficit
4 HERNIATED DISC RELATED
A ) Major Muscle Weakness (strength 3 of 5 or less)
B ) Foot drop
5 VERTEBRAL FRACTURE RELATED
A ) Prolonged use of Corticosteroids
B ) Age greater than 70 years
C ) History of Osteoporosis
D ) Mild Trauma over age 50 years (or with Osteoporosis)
E ) Recent significant Trauma at any age
F ) Ejection from motor vehicle
G ) Fall from substantial height
6 AAA RELATED
A ) Abdominal pulsating mass
B ) Atherosclerotic vascular disease
C ) Pain at rest or nocturnal pain
D ) Age greater than 60 years
7 GENERAL
A ) Vertebral tenderness
B ) Limited spine range of motion