PCPs are front line defense in diagnosing serious illness in patients with acute lower...(onitored patients for 12 months after in...),Health

Date:9/28/2009

onitored patients for 12 months after initial consultation to determine if fracture, infection, arthritis, or cancer was the cause of their lower back pain. The results showed that PCPs identified 5 of the 11 cases of previously undiagnosed serious illnesses during the initial consultation.

Researchers, led by Christopher Maher, Ph.D., noted 8 cases of vertebral fracture, the most common serious disease identified and the only disease for which researchers were able to create a diagnostic rule. The rule contained 4 variables: female sex, age > 70 years, significant trauma (major in young patients, minor in elderly patients), and prolonged use of corticosteroids. When at least 1 of the "red flag" questions was positive, the likelihood ratio (for fracture) was 1.8; with at least 2 positive features, the ratio increased to 15.5 and with 3 positive features it increased to 218.3. "Our rule suggests that when any 3 of the 4 "red flags" are positive, the probability of vertebral fracture greatly increases (e.g., from 0.5% to 52%), said Professor Maher.

The study also uncovered there to be high false-positive rates with some red flag questions. An approach where any positive red flag is acted upon would result in unnecessary referrals to specialists and needless investigation of patients. The authors propose, "A better approach would be to evaluate a combination of red flag questions that identify serious disease while reducing the number of false-positive results." The primary care setting plays a vital role in early detection of serious disease and the authors recommend further research into the diagnostic accuracy of red flags in lower back pain is needed.

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Contact: Dawn Peters medicalnews@wiley.com 781-388-8408 Wiley-Blackwell Source:Eurekalert

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