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Evidence summaries

Red Flags to Screen for Vertebral Fracture in Patients Presenting with Low-Back Pain

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. Level of evidence: "B"

Comment: The quality of evidence is downgraded by study quality

Summary

A Cochrane review [Abstract] 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.

Clinical comments

Note

Date of latest search: 2012-04-22

    References

    • 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. [PubMed]

Primary/Secondary Keywords