Red Flags

• What is a red flag?

  • In a medical context, a red flag is a warning symptom, sign or test result that suggests apotentially serious underlying pathology
  • Their presence or absence adjusts the probabilityof a serious condition – and therefore thethreshold for further tests or referral
• What are the two types of red flags?

  *general *specific
• What is a general red flag?

  General red flags: direct the clinicians to recognise a serious illness even thoughthe exact disease is not known, e.g. unexplained weight loss
• What is a specific red flag?

  Specific red flags: signal specific illnesses and present in specific anatomical regions, e.g. ground coffee vomiting
• What are the techniques for finding red flags?

  • Use open questions and start generally, e.g. ‘What can I do for you?’, followed byfurther ‘open’ investigation, e.g.:
  • ‘Can you tell me a bit more about your symptoms and how they all started’
  • ‘Is there anything else that you think may be important?’
  • ‘And what happened then?’
  • Find out exactly what the reason for the consultation is and explore thepresenting symptom/s in detail
  • Be alert all the time and actively search for ‘hidden’ red flags
  • Be aware of combinations of symptoms that suggest serious disease
• What is the general about lower back pain (red ish flag)?

  • This is where it all started
  • One of the most common presentations in primarycare
  • 1-4% is a fracture
  • <1% is a cancer
  • Despite the potential seriousness of the cause,cannot justify testing everyone for everything
• What are some examples of red flags in lower back pain?

  *fracture*cancer*cauda equina*infection
• What does a lower back pain fracture entail?

  • Prolonged use of corticosteroids
  • Older age (>70 yrs)
  • Hx of osteoporosis
  • Mild trauma > 50yrs with osteoporosis
  • Significant trauma at any age
• What does lower back pain cancer entail?

  • Age <20yrs or >50yrs
  • Previous Hx of cancer
  • Unexplained weight loss
  • Night pain not relieved by rest
  • Failure to improve with Tx
  • Lasts >4-6 weeks
• What does lower back pain cauda equine entail?

  • Saddle anaesthesia
  • Bladder/bowel dysfunction
  • Motor weakness/sensory deficit
• What does lower back pain infection entail?

  *Systemically unwell: fever, chills* Recent bacterial infection* Recent surgery* Immunocompromised
• What are some examples of yellow flags?

  • Belief that pain itself is harmful
  • Sickness behaviours – extended rest
  • Social withdrawal/lack of support*Low mood/depression/anxiety*Problems/dissatisfaction at work
  • Compensation or benefit claims
  • Overprotective family
  • No active participation in treatment