Takaisin Tulosta

Red flags to screen for vertebral fracture in patients presenting with low-back pain

Evidence summaries
Iris Pasternack
17.10.2013New article

Level of evidence: B

Significant trauma, or falls among elderly, older age and corticosteroid use appear to be proper red flags for vertebral fracture in patients presenting with low back pain.

Comment: The quality of evidence is downgraded by study quality

Summary

A Cochrane review «»1 «Williams CM, Henschke N, Maher CG et al. Red flags...»1 included 8 studies with a total of 7378 subjects. Four of the studies were performed in primary care where the prevalence of vertebral fracture ranged from from 0.7% to 4.5%. In the remaining four studies performed in accident and emergency settings the prevalence of vertebral fracture ranged from 6.5% to 11%. Twenty-nine different tests screening for vertebral fracture were identified and their accuracy and usefulness examined: only two of tests featured in more than two studies.

Three red flags in primary care were potentially useful as single tests: significant trauma (LR+ point estimate ranging from 3 to 13), older age (LR+ from 4 to 9), corticosteroid use (LR+ from 4 to 48). The results of combined tests appeared more informative than individual red flags with LR+ estimates generally greater in magnitude and precision.

Date of latest search: 2012-04-22

References

  1. 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;1():CD008643. «PMID: 23440831»PubMed