Resources for General Practitioners
Urinary retention, faecal incontinence, saddle anaesthesia, bilateral neurological signs
Unexplained fever, recent infection (UTI, skin), IV drug abuse, immunosuppression
Male, smoker, 65-75 years old
Progressive motor weakness, or motor deficits at multiple levels
Strong risk factors: history of cancer (especially breast, prostate, lung, thyroid, kidney); strong clinical suspicion
Combination of: female; over 70 years old; significant trauma; prolonged corticosteroid use; presence of contusion or abrasion
Persistent symptoms alternating buttock pain, morning stiffness that improves with movement, better with exercise, awaking with pain in the second part of the night, onset under 40 years old
Acute low back pain can be caused by pathology, but this is very rare.
Red flags are a well-established screening mechanism but many commonly used flags do not meaningfully increase the likelihood of pathology being present.
Screening for pathology also has negative side effects. These include significant radiation exposure, anxiety due to expectation of pathology or incidental findings, and unnecessary subsequent interventions.
now (long pause) try to see that in perspective of the harm that you
cause by trying to exclude serious pathology all the time”
GP WITH 28 YEARS EXPERIENCE
It is important
to differentiate between pathology which requires immediate action
in order to change patient outcome (e.g. cauda equina syndrome,
infection, abdominal aneurysm), and pathology for which delaying
identification by a few weeks will not significantly affect the outcome
(e.g. compression fractures, spinal metastases, ankylosing
Although it is
important that prolonged treatment is not inappropriately directed at
pain of pathological origin, the relative risk of missing these
conditions is low compared to the risks of excessive screening.