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Table 5 Referral for imaging given presence of red flag combinations

From: Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study

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

       

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

       

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)