Purpose

To determine the frequency of red flag signs and symptoms in patients presenting with back pain to the Emergency Department (ED) and association with serious pathologies and investigations performed.

Methods

This retrospective observational study evaluated consecutive patients presenting with back pain to a Melbourne ED over a 14-month period. Data regarding red flags, patient characteristics, ED-initiated investigations, and diagnoses were extracted from medical records. Prevalence of each red flag and sensitivity, specificity, and likelihood ratios for diagnosing serious spinal or non-spinal pathology were calculated.

Results

Analysis was undertaken on 1000 eligible participants with back pain. 69% had red flags. Participants were categorised into diagnostic groups: musculoskeletal (80.6%), serious spinal (3.3%), and serious non-spinal (14.6%) pathologies. A number of red flags had positive likelihood ratios (LR) > 5, indicating a higher probability of serious pathology (spinal/non-spinal) including fever (LR + 68.8), tuberculosis history (LR + 13.8), known nephrolithiasis/abdominal aortic aneurysm (LR + 10.2), unexplained weight-loss (LR + 9.2), writhing in pain (LR + 6.9), urinary symptoms (LR + 5.4), and flank pain (LR + 5.2). Red flags with positive LR > 5 indicating a higher probability of serious spinal pathology were saddle anaesthesia (LR + 11.0), tuberculosis history (LR + 9.8), intravenous drug-use (LR + 6.9), acute-onset urinary retention (LR + 6.4), and anal tone loss (LR + 6.3).

Conclusion

The majority of this study cohort had back pain of benign cause. Some red flags were associated with greater risk of serious pathology, others were not. Further evidence regarding red flags and their association with serious pathology is required, to better inform clinical guidelines.

中文翻译：

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背痛“危险信号”：哪些最能预示急诊科的严重病变？

目的

旨在确定急诊科 (ED) 就诊的背痛患者出现危险信号体征和症状的频率，以及与严重病理和所进行的调查的关系。

方法

这项回顾性观察研究评估了 14 个月内连续因背痛到墨尔本急诊科就诊的患者。从医疗记录中提取有关危险信号、患者特征、急诊室发起的调查和诊断的数据。计算了每个危险信号的发生率以及诊断严重脊柱或非脊柱病理的敏感性、特异性和似然比。

结果

对 1000 名患有背痛的合格参与者进行了分析。69% 有危险信号。参与者被分为诊断组：肌肉骨骼（80.6%）、严重脊柱（3.3%）和严重非脊柱（14.6%）病变。许多危险信号的阳性似然比 (LR) > 5，表明严重病理（脊柱/非脊柱）的可能性较高，包括发烧 (LR + 68.8)、结核病史 (LR + 13.8)、已知的肾结石/腹主动脉瘤动脉瘤（LR + 10.2）、不明原因的体重减轻（LR + 9.2）、疼痛扭动（LR + 6.9）、泌尿系统症状（LR + 5.4）和胁腹痛（LR + 5.2）。LR > 5 阳性的危险信号表明严重脊柱病理的可能性较高，包括鞍麻醉 (LR + 11.0)、结核病史 (LR + 9.8)、静脉吸毒 (LR + 6.9)、急性发作尿潴留 (LR + 6.4),

结论

该研究队列中的大多数人患有良性原因的背痛。一些危险信号与严重病理的更大风险相关，而另一些则不然。需要有关危险信号及其与严重病理学关联的进一步证据，以便更好地为临床指南提供信息。