The reliability of red flags in spinal cord compression

Area of Science:

• Emergency Medicine
• Neurosurgery
• Radiology

Background:

• Acute low back pain is a frequent emergency department (ED) presentation.
• Most cases (95%) have benign causes, necessitating identification of serious conditions via red flags.

Purpose of the Study:

• To evaluate the effectiveness of red flag signs in the ED for detecting spinal cord and cauda equina compression.

Main Methods:

• Retrospective cohort study of 206 patients with acute back pain admitted from the ED.
• Assessed red flag symptoms against magnetic resonance imaging (MRI) findings for spinal cord or cauda equina compression.

Main Results:

• 15.5% of patients showed compression on MRI.
• Bowel/bladder dysfunction (LR 2.45) and saddle sensory disturbance (LR 2.11) were significant predictors.
• Combined symptoms yielded a likelihood ratio (LR) of 3.46, with low sensitivity but high specificity.

Conclusions:

• The studied red flags only slightly increase clinical suspicion for spinal cord or cauda equina compression.
• Current red flag criteria are insufficient for effective risk stratification in the ED setting for acute back pain.