1,563
Views
30
CrossRef citations to date
0
Altmetric
Reviews

The diagnostic value of Red Flags in thoracolumbar pain: a systematic review

ORCID Icon, , , , & ORCID Icon
Pages 1190-1206 | Received 01 Jan 2020, Accepted 29 Jul 2020, Published online: 19 Aug 2020

References

  • Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791–2803.
  • Koes BW, van Tulder M, Lin CC, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075–2094.
  • Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int. 2019;39(4):619–626.
  • Verhagen AP, Downie A, Popal N, et al. Red flags presented in current low back pain guidelines: a review. Eur Spine J. 2016;25(9):2788–2802.
  • Spencer L, McKenna L, Fary R, et al. Upper back pain in postmenopausal women and associated physical characteristics. PLoS One. 2019;14(7):e0220452.
  • Briggs AM, Smith AJ, Straker LM, et al. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10(1):77.
  • Geyser M, Smith S. Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria. Afr J Prim Health Care Fam Med. 2016;8(1):e1–e5.
  • Buntinx F, Knockaert D, Bruyninckx R, et al. Chest pain in general practice or in the hospital emergency department: is it the same? Fam Pract. 2001;18(6):586–589.
  • Hickam DH. Chapter 9. Chest pain or discomfort. In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations. 3rd ed. Boston (MA): Butterworths; 1990. p. 72–75.
  • Burton AK, Balagué F, Cardon G, et al. Chapter 2: European guidelines for prevention in low back pain. Eur Spine J. 2006;15(S2):s136–s168.
  • Goodman CC, Heick J, Lazaro RT. Differential diagnosis for physical therapist: screening for referral. 6th ed. Philadelphia (PA): Saunders; 2018.
  • Cook CE, George SZ, Reiman MP. Red flag screening for low back pain: nothing to see here, move along: a narrative review. Br J Sports Med. 2018;52(8):493–496.
  • Henschke N, Maher CG, Refshauge KM. Screening for malignancy in low back pain patients: a systematic review. Eur Spine J. 2007;16(10):1673–1679.
  • Henschke N, Maher CG, Refshauge KM. A systematic review identifies five “red flags” to screen for vertebral fracture in patients with low back pain. J Clin Epidemiol. 2008;61(2):110–118.e1.
  • Koes BW, van Tulder MW, Ostelo R, et al. Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine. 2001;26(22):2504–2513.
  • Henschke N, Keuerleber J, Ferreira M, et al. The methodological quality of diagnostic test accuracy studies for musculoskeletal conditions can be improved. J Clin Epidemiol. 2014;67(4):416–424.
  • Williams CM, Henschke N, Maher CG, et al. Red flags to screen for vertebral fracture in patients presenting with low-back pain. Cochrane Database Syst Rev. 2013;3(1):CD008643.
  • Henschke N, Maher CG, Ostelo RW, et al. Red flags to screen for malignancy in patients with low-back pain. Cochrane Database Syst Rev. 2013;28(2):CD008686.
  • Ramanayake RJC, Basnayake BT. Evaluation of red flags minimizes missing serious diseases in primary care. J Fam Med Prim Care. 2018;7(2):315–318.
  • Finucane LM, Downie A, Mercer C, et al. International framework for Red Flags for potential serious spinal pathologies. J Orthop Sports Phys Ther. 2020;50(7):350–372.
  • Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013;347:f7095.
  • Verhagen AP, Downie A, Maher CG, et al. Most red flags for malignancy in low back pain guidelines lack empirical support: a systematic review. Pain. 2017;158(10):1860–1868.
  • Parreira PCS, Maher CG, Traeger AC, et al. Evaluation of guideline-endorsed red flags to screen for fracture in patients presenting with low back pain. Br J Sports Med. 2019;53(10):648–654.
  • Yousef E, Abdulaziz A. Pediatric chest pain: the Red Flags? J Cardiol Cardiovasc Ther. 2017;7(4):555720.
  • MacKnight JM, Mistry DJ. Chest pain in the athlete: differential diagnosis, evaluation, and treatment. Clin Rev Allergy Immunol. 2005;29(2):87–96.
  • Hung C, Hou CJ, Yeh H, et al. Atypical chest pain in the elderly: prevalence, possible mechanisms and prognosis. Int J Gerontol. 2010;4(1):1–8.
  • Body R, Carley S, Wibberley C, et al. The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes. Resuscitation. 2010;81(3):281–286.
  • Premkumar A, Godfrey W, Gottschalk MB, et al. Red Flags for low back pain are not always really red: a prospective evaluation of the clinical utility of commonly used screening questions for Low Back Pain. J Bone Joint Surg Am. 2018;100(5):368–374.
  • Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–e34.
  • Altman DG. Practical statistics for medical research. London (UK): Chapman and Hall; 1991.
  • McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276–282.
  • Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions. 2nd ed. Chichester (UK): Wiley; 2019.
  • Ahad A, Elsayed M, Tohid H. The accuracy of clinical symptoms in detecting cauda equina syndrome in patients undergoing acute MRI of the spine. Neuroradiol J. 2015;28(4):438–442.
  • Albarran J, Durham B, Gowers J, et al. Is the radiation of chest pain a useful indicator of myocardial infarction? A prospective study of 541 patients. Accid Emerg Nurs. 2002;10(1):2–9.
  • Aydin F, Aksit E, Yildirim OT, et al. Chest pain score: a novel and practical approach to angina pectoris. A diagnostic accuracy study. Sao Paulo Med J. 2019;137(1):54–59.
  • Bernard Bagattini S, Bounameaux H, Perneger T, et al. Suspicion of pulmonary embolism in outpatients: nonspecific chest pain is the most frequent alternative diagnosis. J Intern Med. 2004;256(2):153–160.
  • Balasubramanian K, Kalsi P, Greenough CG, et al. Reliability of clinical assessment in diagnosing cauda equina syndrome. Br J Neurosurg. 2010;24(4):383–386.
  • Broderick C, Hopkins S, Mack DJF, et al. Delays in the diagnosis and treatment of bone and joint tuberculosis in the United Kingdom. Bone Joint J. 2018;100-B(1):119–124.
  • Cook C, Ross MD, Isaacs R, et al. Investigation of nonmechanical findings during spinal movement screening for identifying and/or ruling out metastatic cancer. Pain Pract. 2012;12(6):426–433.
  • Courtney DM, Kline JA, Kabrhel C, et al. Clinical features from the history and physical examination that predict the presence or absence of pulmonary embolism in symptomatic emergency department patients: results of a prospective, multicenter study. Ann Emerg Med. 2010;55(4):307–315.e1.
  • de Schepper EIT, Koes BW, Veldhuizen EFH, et al. Prevalence of spinal pathology in patients presenting for lumbar MRI as referred from general practice. Fam Pract. 2016;33(1):51–56.
  • Domen PM, Hofman PA, van Santbrink H, et al. Predictive value of clinical characteristics in patients with suspected cauda equina syndrome. Eur J Neurol. 2009;16(3):416–419.
  • Donner-Banzhoff N, Roth T, Sönnichsen AC, et al. Evaluating the accuracy of a simple heuristic to identify serious causes of low back pain. Fam Pract. 2006;23(6):682–686.
  • Dugas AF, Lucas JM, Edlow JA. Diagnosis of spinal cord compression in nontrauma patients in the emergency department. Acad Emerg Med. 2011;18(7):719–725.
  • Enthoven WT, Geuze J, Scheele J, et al. Prevalence and “Red Flags” regarding specified causes of back pain in older adults presenting in general practice. Phys Ther. 2016;96(3):305–312.
  • Everden A, Mamo JP, Somasunderam D, et al. Bone and joint mycobacterial infection: a retrospective review of cases presenting to a UK district hospital. J Med Microbiol. 2018;67(12):1698–1705.
  • Gesuete V, Fregolent D, Contorno S, et al. Follow-up study of patients admitted to the pediatric emergency department for chest pain. Eur J Pediatr. 2020;179(2):303–308.
  • Goodacre S, Locker T, Morris F, et al. How useful are clinical features in the diagnosis of acute, undifferentiated chest pain? Acad Emerg Med. 2002;9(3):203–208.
  • Harding IJ, Davies E, Buchanan E, et al. The symptom of night pain in a back pain triage clinic. Spine. 2005;30(17):1985–1988.
  • Henschke N, Maher CG, Refshauge KM, et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009;60(10):3072–3080.
  • Holmes JF, Panacek EA, Miller PQ, et al. Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients. J Emerg Med. 2003;24(1):1–7.
  • Hsu JM, Joseph T, Ellis AM. Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury. 2003;34(6):426–433.
  • Karlaftis A, Karamanolis G, Triantafyllou K, et al. Clinical characteristics in patients with non-cardiac chest pain could favor gastroesophageal reflux disease diagnosis. Ann Gastroenterol. 2013;26(4):314–318.
  • Kempthorne JT, Pratt C, Smale EL, et al. Ten-year review of extradural spinal abscesses in a New Zealand tertiary referral centre. J Clin Neurosci. 2009;16(8):1038–1042.
  • Ko SY, Kim SI, Kim JH, et al. Clinically distinct characteristics in patients younger than 40 years old with non-cardiac chest pain. J Gastroenterol Hepatol. 2012;27(9):1484–1489.
  • Milner KA, Funk M, Arnold A, et al. Typical symptoms are predictive of acute coronary syndromes in women. Am Heart J. 2002;143(2):283–288.
  • Punukollu H, Khan IA, Punukollu G, et al. Acute pulmonary embolism in elderly: clinical characteristics and outcome. Int J Cardiol. 2005;99(2):213–216.
  • Tobias N, Raison J, Alwan W, et al. The reliability of Red Flags in spinal cord compression. Arch Trauma Res. 2014;3(1):e17850.
  • Reuter P, Pradeau C, Huo Yung Kai S, et al. Predicting acute coronary syndrome in males and females with chest pain who call an emergency medical communication centre. Scand J Trauma Resusc Emerg Med. 2019;27(1):92.
  • Roman M, Brown C, Richardson W, et al. The development of a clinical decision making algorithm for detection of osteoporotic vertebral compression fracture or wedge deformity. J Man Manip Ther. 2010;18(1):44–49.
  • Sánchez M, López B, Bragulat E, et al. Triage flowchart to rule out acute coronary syndrome. Am J Emerg Med. 2007;25(8):865–872.
  • Schillinger M, Sodeck G, Meron G, et al. Acute chest pain—identification of patients at low risk for coronary events. The impact of symptoms, medical history and risk factors. Wien Klin Wochenschr. 2004;116(3):83–89.
  • Shaw B, Kinsella R, Henschke N, et al. Back pain “red flags”: which are most predictive of serious pathology in the emergency department? Eur Spine J. 2020;48(8):27.
  • Park SH, Choi JY, Park EJ, et al. Prevalence of gastrointestinal diseases and treatment status in noncardiac chest pain patients. Korean Circ J. 2015;45(6):469–472.
  • Svensson L, Isaksson L, Axelsson C, et al. Predictors of myocardial damage prior to hospital admission among patients with acute chest pain or other symptoms raising a suspicion of acute coronary syndrome. Coron Artery Dis. 2003;14(3):225–231.
  • Thiruganasambandamoorthy V, Turko E, Ansell D, et al. Risk factors for serious underlying pathology in adult emergency department nontraumatic low back pain patients. J Emerg Med. 2014;47(1):1–11.
  • Timmons S, Kingston M, Hussain M, et al. Pulmonary embolism: differences in presentation between older and younger patients. Age Ageing. 2003;32(6):601–605.
  • Tsiang JT, Kinzy TG, Thompson N, et al. Sensitivity and specificity of patient-entered red flags for lower back pain. Spine J. 2019;19(2):293–300.
  • Van den Bosch MA, Hollingworth W, Kinmonth AL, et al. Evidence against the use of lumbar spine radiography for low back pain. Clin Radiol. 2004;59(1):69–76.
  • Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000;83(03):416–420.
  • Turner T, Green S, Tovey D, et al. Producing Cochrane systematic reviews—a qualitative study of current approaches and opportunities for innovation and improvement. Syst Rev. 2017;6(1):147.
  • McGee S. Simplifying likelihood ratios. J Gen Intern Med. 2002;17(8):647–650.
  • Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.
  • Mendeley [Internet]. Philadelphia (PA): Saunders; 2020. Available from: https://www.mendeley.com/?interaction_required=true
  • Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–605.
  • Patel ND, Broderick DF, Burns J, et al. ACR appropriateness criteria low back pain. J Am Coll Radiol. 2016;13(9):1069–1078.
  • Dionne N, Adefolarin A, Kunzelman D, et al. What is the diagnostic accuracy of red flags related to cauda equina syndrome (CES), when compared to magnetic resonance imaging (MRI)? A systematic review. Musculoskelet Sci Pract. 2019;42:125–133.
  • Šimundić AM. Measures of diagnostic accuracy: basic definitions. EJIFCC. 2009;19(4):203–211.
  • Cawthon PM. Gender differences in osteoporosis and fractures. Clin Orthop Relat Res. 2011;469(7):1900–1905.
  • Lurie JD. What diagnostic tests are useful for low back pain? Best Pract Res Clin Rheumatol. 2005;19(4):557–575.
  • Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012;85(4):343–350.
  • Arce D, Sass P, Abul-Khoudoud H. Recognizing spinal cord emergencies. Am Fam Physician. 2001;64(4):631–638.
  • Bowers B. Recognising metastatic spinal cord compression. Br J Community Nurs. 2015;20(4):162–165.
  • Della-Giustina D, Kilcline BA. Acute low back pain: a comprehensive review. Compr Ther. 2000;26(3):153–159.
  • Della-Giustina DA. Emergency department evaluation and treatment of back pain. Emerg Med Clin North Am. 1999;17(4):877–893.
  • Dudler J, Balague F. What is the rational diagnostic approach to spinal disorders? Best Pract Res Clin Rheumatol. 2002;16(1):43–57.
  • Lin L, Chu H. Quantifying publication bias in meta-analysis. Biometrics. 2018;74(3):785–794.
  • PROSPERO [Internet]. York (UK): Centre for Reviews and Dissemination University of York; 2020. Available from: https://www.crd.york.ac.uk/prospero

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.