- Title
- Red flags to screen for vertebral fracture in people presenting with low back pain
- Creator
- Han, Christopher S.; Hancock, Mark J.; Downie, Aron; Jarvik, Jeffrey G.; Koes, Bart W.; Machado, Gustavo C.; Verhagen, Arianne P.; Williams, Christopher M.; Chen, Qiuzhe; Maher, Christopher G.
- Relation
- The Cochrane database of systematic reviews Vol. 2023, Issue 8, no. CD014461
- Publisher Link
- http://dx.doi.org/10.1002/14651858.CD014461.pub2
- Publisher
- Wiley-Blackwell
- Resource Type
- journal article
- Date
- 2023
- Description
- Background: Low back pain is a common presentation across different healthcare settings. Clinicians need to confidently be able to screen and identify people presenting with low back pain with a high suspicion of serious or specific pathology (e.g. vertebral fracture). Patients identified with an increased likelihood of having a serious pathology will likely require additional investigations and specific treatment. Guidelines recommend a thorough history and clinical assessment to screen for serious pathology as a cause of low back pain. However, the diagnostic accuracy of recommended red flags (e.g. older age, trauma, corticosteroid use) remains unclear, particularly those used to screen for vertebral fracture. Objectives: To assess the diagnostic accuracy of red flags used to screen for vertebral fracture in people presenting with low back pain. Where possible, we reported results of red flags separately for different types of vertebral fracture (i.e. acute osteoporotic vertebral compression fracture, vertebral traumatic fracture, vertebral stress fracture, unspecified vertebral fracture). Search methods: We used standard, extensive Cochrane search methods. The latest search date was 26 July 2022. Selection criteria: We considered primary diagnostic studies if they compared results of history taking or physical examination (or both) findings (index test) with a reference standard test (e.g. X‐ray, magnetic resonance imaging (MRI), computed tomography (CT), single‐photon emission computerised tomography (SPECT)) for the identification of vertebral fracture in people presenting with low back pain. We included index tests that were presented individually or as part of a combination of tests. Data collection and analysis: Two review authors independently extracted data for diagnostic two‐by‐two tables from the publications or reconstructed them using information from relevant parameters to calculate sensitivity, specificity, and positive (+LR) and negative (−LR) likelihood ratios with 95% confidence intervals (CIs). We extracted aspects of study design, characteristics of the population, index test, reference standard, and type of vertebral fracture. Meta‐analysis was not possible due to heterogeneity of studies and index tests, therefore the analysis was descriptive. We calculated sensitivity, specificity, and LRs for each test and used these as an indication of clinical usefulness. Two review authors independently conducted risk of bias and applicability assessment using the QUADAS‐2 tool.
- Subject
- low back pain; vertebral fracture; spinal Fractures; aging
- Identifier
- http://hdl.handle.net/1959.13/1488272
- Identifier
- uon:52399
- Identifier
- ISSN:1469-493X
- Language
- eng
- Reviewed
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