Red Flags

Question 1

What is a red flag?

Answer 1

• In a medical context, a red flag is a warning symptom, sign or test result that suggests a
  potentially serious underlying pathology
• Their presence or absence adjusts the probability
  of a serious condition – and therefore the
  threshold for further tests or referral

Question 2

What are the two types of red flags?

Answer 2

*general
*specific

Question 3

What is a general red flag?

Answer 3

General red flags: direct the clinicians to recognise a serious illness even though
the exact disease is not known, e.g. unexplained weight loss

Question 4

What is a specific red flag?

Answer 4

Specific red flags: signal specific illnesses and present in specific anatomical regions, e.g. ground coffee vomiting

Question 5

What are the techniques for finding red flags?

Answer 5

• Use open questions and start generally, e.g. ‘What can I do for you?’, followed by
  further ‘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 the
  presenting 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

Question 6

What is the general about lower back pain (red ish flag)?

Answer 6

• This is where it all started
• One of the most common presentations in primary
  care
• 1-4% is a fracture
• <1% is a cancer
• Despite the potential seriousness of the cause,
  cannot justify testing everyone for everything

Question 7

What are some examples of red flags in lower back pain?

Answer 7

*fracture
*cancer
*cauda equina
*infection

Question 8

What does a lower back pain fracture entail?

Answer 8

• Prolonged use of corticosteroids
• Older age (>70 yrs)
• Hx of osteoporosis
• Mild trauma > 50yrs with osteoporosis
• Significant trauma at any age

Question 9

What does lower back pain cancer entail?

Answer 9

• 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

Question 10

What does lower back pain cauda equine entail?

Answer 10

• Saddle anaesthesia
• Bladder/bowel dysfunction
• Motor weakness/sensory deficit

Question 11

What does lower back pain infection entail?

Answer 11

*Systemically unwell: fever, chills
* Recent bacterial infection
* Recent surgery
* Immunocompromised

Question 12

What are some examples of yellow flags?

Answer 12

• 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