The Reliability of Red Flags in Spinal Cord Compression

Raison, N. T. J. and Alwan, W. and Abbot, A. and Farook, M. and Khaleel, A. (2014) The Reliability of Red Flags in Spinal Cord Compression. Arch Trauma Res, 3 (1). e17850.


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Background: Acute low back pain is a common cause for presentation to the emergency department (ED). Since benign etiologies account for 95% of cases, red flags are used to identify sinister causes that require prompt management. Objectives: We assessed the effectiveness of red flag signs used in the ED to identify spinal cord and cauda equine compression. Patients and Methods: It was a retrospective cohort study of 206 patients with acute back pain admitted from the ED. The presence or absence of the red flag symptoms was assessed against evidence of spinal cord or cauda equina compression on magnetic resonance imaging (MRI). Results: Overall, 32 (15.5%) patients had compression on MRI. Profound lower limb neurologic examination did not demonstrate a statistically significant association with this finding. The likelihood ratio (LR) for bowel and bladder dysfunction (sensitivity of 0.65 and specificity of 0.73) was 2.45. Saddle sensory disturbance (sensitivity of 0.27 and specificity of 0.87) had a LR of 2.11. When both symptoms were taken together (sensitivity of 0.27 and specificity of 0.92), they gave a LR of 3.46. Conclusions: The predictive value of the two statistically significant red flags only marginally raises the clinical suspicion of spinal cord or cauda equina compression. Effective risk stratification of patients presenting to the ED with acute back pain is crucial; however, this study did not support the use of these red flags in their current form.

Item Type: Article
Subjects: Medicine
Divisions: Archives of Trauma Research journal
Depositing User: ART . editor
Date Deposited: 30 Apr 2017 18:03
Last Modified: 05 Aug 2017 12:47

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