Red flag criteria indicating imaging may be warranted | Meeting criteria N (% of 498) | Referred for imaging by chiropractor | Referred for imaging by other health care professional | Referred for imaging combined | |||
---|---|---|---|---|---|---|---|
#/N | % (95% CI) | # / N | % (95% CI) | # / N | % (95% CI) | ||
Neoplasm | Â | Â | Â | Â | Â | Â | Â |
History of cancer, unexplained weight loss, (considerable LBP and age 50 +), and failure of conservative care | 0 (0.0%) | – |  | – |  | – |  |
History of cancer, failure of conservative care | 1 (0.2%) | 1/1 | 100 (3–100) | 0/1 | 0 (0–97) | 1/1 | 100 (3–100) |
History of cancer, (considerable LBP and age 50 +) | 2 (0.4%) | 1/2 | 50 (1–99) | 0/2 | 0 (0–84) | 1/2 | 50 (1–99) |
Spinal fracture | |||||||
Recent significant trauma (any age) | 25 (5.0%) | 1/25 | 4 (0–20) | 0/25 | 0 (0–14) | 1/25 | 4 (0–20) |
Severe pain with minor trauma, age 50 +  | 19 (3.8%) | 4/19 | 21 (6–46) | 0/19 | 0 (0–18) | 4/19 | 21 (6–46) |
History of prolonged corticosteroid use | 14 (2.8%) | 0/14 | 0 (0–23) | 1/14 | 7 (0–34) | 1/14 | 7 (0–34) |
Structural deformity | 2 (0.4%) | 0/2 | 0 (0–84) | 0/2 | 0 (0–84) | 0/2 | 0 (0–84) |
History of/high risk for osteoporosis | 16 (3.2%) | 2/16 | 13 (2–38) | 0/16 | 0 (0–21) | 2/16 | 13 (2–38) |
Spinal infection | Â | Â | Â | Â | Â | Â | Â |
Documented fever > 3 weaks, no established diagnosis, Age 50 +  | 1 (0.2%) | 1/1 | 100 (3–100) | 0/1 | 0 (0–97) | 1/1 | 100 (3–100) |
Diabetic | 45 (9.0%) | 4/45 | 9 (2–21) | 0/45 | 0 (0 -8) | 4/45 | 9 (2–21) |
Immunosuppressed | 22 (4.4%) | 1/22 | 5 (0–23) | 0/22 | 0 (0–15) | 1/22 | 5 (0–23) |
Embedded Foreign object | 2 (0.4%) | 0/2 | 0 (0–84) | 0/2 | 0 (0–84) | 0/2 | 0 (0–84) |
IV drug abuse | 3 (0.6%) | 0/3 | 0 (0–71) | 0/3 | 0 (0–71) | 0/3 | 0 (0–71) |
Inflammatory low back pain | |||||||
Morning stiffness > 30 min, improvement of pain with exercise but not rest, awakening 2nd half of night due to back pain | 0 (0.0%) | – |  | – |  | – |  |
Any two of (morning stiffness > 30 min, improvement of pain with exercise but not rest, awakening 2nd half of night due to back pain) | 1 (0.2%) | 0/1 | 0 (0–97) | 0/1 | 0 (0–97) | 0/1 | 0 (0–97) |
Suspected sciatica—lumbar disc herniation, spondylolisthesis, degenerative spinal stenosis | |||||||
Progressive neurological deficits with at least one of (age 50 + , failure of conservative care, significant activity limitations) | 3 (0.6%) | 2/3 | 67 (9–99) | 1/3 | 33 (1–91) | 3/3 | 100 (30–100) |