The term red flags (PDF 113KB) refers to clinical features that help to identify the presence of potentially serious conditions. Such conditions include tumours, infection, fractures and neurological damage.
Screening for serious conditions must occur during history taking at initial assessment and may be followed up with specific physical tests during examination.
Red flags indicate the need to consider further investigation and/or referral to an appropriate specialist.
Types of clinical red flags
Clinical red flags for your patient include:
Cauda Equina Syndrome
Features of Cauda Equina Syndrome include some or all of: urinary retention, faecal incontinence, widespread neurological symptoms and signs in the lower limb(s), gait abnormality, saddle area numbness and a lax anal sphincter.
Acute Cauda Equina Syndrome is a medical emergency and requires urgent hospital referral.
history of cancer
intravenous drug use
over 55 years at age of onset
severe, unremitting night-time pain
Recommended approach for red flags
If red flags are present the following approach is recommended:
all patients with symptoms or signs of Cauda Equina Syndrome should be referred urgently to a hospital for orthopaedic or neurosurgical assessment
patients with Red Flags should be investigated appropriately and referred to a specialist if indicated by clinical findings and test results
investigations in an episode of acute low back pain do not provide clinical benefit, unless there are red flags. Radiological imaging (x-rays and CT scans) carry the risk of potential harm from radiation-related effects and should be avoided if not necessary for diagnosis or management
a full blood count and ESR should usually be performed only if there are red flags. Other tests may be indicated depending on the clinical situation
remember, red flag pathology may lie outside the lumbar region and may not be detected by radiology.
You can search through to find related information.
Lumbar disorders: screening for red flags
PDF 112 KB
Lumbar disorders - a diagnostic guide
PDF 177 KB
Triage and referral guideline - the assessment of lumbar disorders
PDF 151 KB
Yellow Flag screening in lumbar disorders
Low back pain Yellow Flags - psychosocial factors that increase the risk of long-term disability and work loss associated with lumbar disorders.
Referring your patient with a lumbar disorder
Referring patients for lumbar disorders - advice and forms for referring patients to specialist clinics at the Royal Adelaide Hospital
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