Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags - A Systematic Review.

Galliker, Gabriela; Scherer, Dominique Eva; Trippolini, Maurizio Alen; Rasmussen-Barr, Eva; LoMartire, Riccardo; Wertli, Maria Monika (2020). Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags - A Systematic Review. The American journal of medicine, 133(1), 60-72.e14. Elsevier 10.1016/j.amjmed.2019.06.005

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BACKGROUND Very little evidence is available on the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting to the emergency department (ED). This systematic review aims to investigate the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting with low back pain to the ED. METHODS We systematically searched MEDLINE, PUBMED, EMBASE, Cochrane Library, and SCOPUS from inception to January 2019. Two reviewers independently reviewed the references and evaluated methodological quality. RESULTS We analyzed 22 studies with a total of 41'320 patients. The prevalence of any serious spinal pathology requiring immediate/urgent treatment was 2.5-5.1% in prospective and 0.7-7.4% in retrospective studies (0.0-7.2% for vertebral fractures, 0.0-2.1% for spinal cancer, 0.0-1.9% for infectious disorders, 0.1-1.9% for pathologies with spinal cord/cauda equina compression, 0.0-0.9% for vascular pathologies). Examples of red flags which increased the likelihood for a serious condition were: suspicion and/or history of cancer (spinal cancer); intravenous drug use, indwelling vascular catheter, other infection site (epidural abscess). CONCLUSION We found a higher prevalence of serious spinal pathologies in the ED compared to the reported prevalence in primary care settings. As the diagnostic accuracy of most red flags was reported only by a single study, further validation in high quality prospective studies is needed.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Wertli, Maria Monika

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1555-7162

Publisher:

Elsevier

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

19 Aug 2019 14:11

Last Modified:

04 Jul 2020 02:30

Publisher DOI:

10.1016/j.amjmed.2019.06.005

PubMed ID:

31278933

BORIS DOI:

10.7892/boris.132072

URI:

https://boris.unibe.ch/id/eprint/132072

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