Scribd Logo
Upload

Welcome to Scribd!

  • Red Flags

    Uploaded by

    Heidi
    430 views2 pages
    Tests with reasonable sensitivity or validity for ruling out or identifying non-musculoskeletal pathology or serious conditions in individuals with complaints of musculoskeletal pain.

    Original Title

    Red flags

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Tests with reasonable sensitivity or validity for ruling out or identifying non-musculoskeletal pathology or serious conditions in individuals with complaints of musculoskeletal pain.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    430 views2 pages

    Red Flags

    Uploaded by

    Heidi
    Tests with reasonable sensitivity or validity for ruling out or identifying non-musculoskeletal pathology or serious conditions in individuals with complaints of musculoskeletal pain.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    BaselineClinicalExamScreeningTestsforSelectRedFlags

    Body region
    Cervical

    Diagnosis
    Myelopathy

    Fracture
    Instability

    Cervical Arterial
    Dissection

    Malignancy

    Upper Extremity

    Coronary Artery
    Disease (CAD)

    Elbow Fracture

    Lumbo-pelvic

    Fracture

    Malignancy

    Cauda Equina
    Syndrome

    Sx/Sy
    CPR:
    - Age > 45
    - Gait abnormality
    - + Babinski
    - +Inverted Supinator
    - +Hoffmans
    Refer to Canadian C-spine
    rules
    Hx of trauma; RA, Down
    Syndrome; signs of cord
    compression
    - + Sharp Pursor
    - + Alar Ligament
    - + Anterior Shear
    - Age > 40
    - Recent head/neck trauma
    - Recent infection
    - Migraines
    CPR:
    - Past hx of CA
    - Age >50
    - Recent unexplained weight
    loss
    - Failed conservative tx
    CPR:
    - Females > 65, males > 55
    - Known clinical vascular
    disease
    - Pain worse during exercise
    - Pain not reproducible by
    palpation
    - Patient believes pain is of
    cardiac origin
    - Elbow Extension Test

    CPR:
    - Age > 50
    - Female gender
    - Major trauma
    - Pain and tenderness
    - Distracting injury
    - Pelvic palpation
    CPR:
    - Past hx of CA
    - Age >50
    - Recent unexplained weight
    loss
    - Failed conservative treatment
    - Urinary Retention
    - Bladder dysfunction
    - Major limb motor
    dysfunction
    - Saddle anesthesia

    Diagnostic Accuracy
    1/5: Sn .94, Sp .31
    2/5: Sn .39, Sp .88
    3/5: Sn .19, Sp .99
    4/5: Sn .09, Sp 1.0
    (Cook, 2010)
    Sn .9-1.0
    (Michaleff, 2012)
    No clustered statistics
    published
    Sharp Pursor: Sn .69, Sp
    .96, +LR 17.3
    (Forrester, 1999)
    No published statistics

    Sn 1.0 (if all four absent)


    (Deyo, 1988)

    Sn .98 (if two criteria met)


    (Bosner, 2010)

    Sn .97, Sp .49
    -LR: .03 (adults), .11
    (children)
    (Appelboam, 2008)
    Unvalidated CPR
    (Henschke, 2008)

    Sn .98, Sp .94, +LR 16.3


    (McCormick, 2003)
    Sn 1.0 (if all four absent)
    (Deyo, 1988)

    No clustered statistics
    published.
    Urinary Retention: Sn .90,
    Sp .95, +LR 18, -LR0.1
    (Deyo, 1992)

    Ankylosing
    Spondylitis

    Knee Fracture

    Malignancy
    Lower Extremity

    CPR:
    - Morning stiffness > 30
    minutes
    - Improvement with exercise
    - Waking with back pain in the
    second half of the night
    - Alternating buttock pain
    CPR:
    - Age > 55
    - Isolated patellar tenderness
    - Isolated fibular head
    tenderness
    - Inability to actively flex knee
    to 90 degrees
    - Inability to bear weight x 4
    steps immediately following
    injury and in the ED
    CPR:
    - Past hx of CA
    - Age >50
    - Recent unexplained weight
    loss
    - Failed conservative treatment

    2/4: Sn .70, Sp .81, +LR


    3.7
    3/4: +LR 12.4
    (Rudwaleit, 2006)

    Sn .98, -LR .05


    (Bachmann, 2004)

    Sn 1.0 (if all four absent)


    (Deyo, 1988)

    Deep Vein
    Thrombosis

    Refer to Wells Criteria

    Sn .82, Sp .22, +LR 1.06


    (Tagelagi, 2007)

    Ankle/Foot Fracture

    CPR:
    - Isolated medial/lateral
    malleolus, navicular, or base of
    the 5th metatarsal bony
    tenderness
    - Inability to bear weight x 4
    steps immediately following
    injury and in the ED

    Sn 1.0 (if all absent)


    (Stiell, 1993)

    References
    1. Cook, C. Clustered clinical findings for diagnosis of cervical spine myelopathy.
    2. Michaleff, Z. Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients
    following blunt trauma: a systematic review.
    3. Forrester, GA et al. Reliability and Validity of the Sharp-Purser Test in the Assessment of Atlanto-axial Instability in Patients with
    Rheumatoid Arthritis. Physiotherapy, Volume 85 , Issue 7 , 376.
    4. Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. Journal of General
    Internal Medicine 1988;3:2308.
    5. Bsner S, Haasenritter J, Becker A, et al. Ruling out coronary artery disease in primary care: development and validation of a
    simple prediction rule. CMAJ. 2010;182(2):1295-1300.
    6. Appelboam A, Reuben A D, Benger J R, Beech F, Dutson J, Haig S et al. Elbow extension test to rule out elbow fracture:
    multicentre, prospective validation and observational study of diagnostic accuracy in adults and children BMJ 2008; 337:a2428.
    7. Henschke N. A systematic review identifies five "red flags" to screen for vertebral fracture in patients with low back pain.
    8. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us
    about low back pain? JAMA 1992;268:7605.
    9. McCormick, JP. Clinical effectiveness of the physical examination in diagnosis of posterior pelvic ring injuries.
    10. Rudwaleit M, Metter A, Listing J, Sieper J, Braun J. Inflammatory back pain in ankylosing spondylitis. Arthritis Rheum.
    2006;54;569-578.
    11. Bachmann, LM. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review.
    12. Tagelagi M, Elley CR. Accuracy of the Wells Rule in diagnosing deep vein thrombosis in primary health care.
    13. Steill IG. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation.

    You might also like