Patients with acute lower back pain can be diagnosed by PCP

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Primary care physicians are front line defense in diagnosing serious illness in patients with acute lower back pain, revealed by researchers at The George Institute for International Health in Australia.

The study is published in the October issue of Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.

In this study a total of 170 general medical practitioners (Australian equivalent to PCP), physiotherapists, and chiropractors in the Sydney area were recruited. Between 2003 and 2005, the clinicians screened 3,184 patients with 1,172 presenting with acute low back pain. These patients were assessed for the presence of red flags for serious disease. The term “red flag” means danger and is used as a warning signal. In healthcare settings “red flag” clinical features, e.g. unexplained weight loss, are used by PCPs to screen for low back pain patients who are more likely to have a serious disease and so require more extensive diagnostic work-up.

Researchers, led by Christopher Maher, Ph.D., noted 8 cases of vertebral fracture, the most common serious disease identified and the only disease for which researchers were able to create a diagnostic rule.

The authors propose, “A better approach would be to evaluate a combination of red flag questions that identify serious disease while reducing the number of false-positive results.”

The primary care setting plays a vital role in early detection of serious disease and the authors recommend further research into the diagnostic accuracy of red flags in lower back pain is needed.

Article: “Prevalence of and Screening for Serious Spinal Pathology in Patients Presenting to Primary Care Settings With Acute Low Back Pain” Nicholas Henschke, Christopher G. Maher, Kathryn M. Refshauge, Robert D. Herbert, Robert G. Cumming, Jane Bleasel, John York, Anurina Das, and James H. McAuley. Arthritis & Rheumatism; Published Online: September 29, 2009 (DOI 10.1002/art.24853); Print Issue Date: October 2009.

Source: Wiley-Blackwell, USA

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