The International Framework for Red Flags and Serious Spinal Pathologies has been published in JOSPT. Kudos to the authors and JOSPT for making this crucial publication open access to all.
Red flags are an essential part of your assessment regardless of which speciality you work in. It’s a complex game and in the context of this publication, red flags have historically been used to guide clinicians to identify serious spinal pathology. The problem is the guidelines are inconsistent resulting in pathology being missed or false suspicion escalating to expensive tests and investigations and medicalisation. This framework aims to support all healthcare professionals by providing a standardised and consistent approach to identifying people with potential serious spinal pathology.
It is great to see how much importance this framwork puts on having clear and honest communication with people who may have serious spinal pathology is. Throughout the How to Use This Framework section you will be shown how to have vital conversations with your patients and how to make then feel reassured and supported.
The core focus of the framework is to provide a decision tool for early identification of serious spinal pathology. To do this a 3 step approach is taken. Images of step 1 & 2 are available within the article itself. The decision tool is shared below.
- Determine your level of concern.
Consider the evidence to support red flagsand the individual profile of the person’s health determinants (eg, age, sex) to decide your level of concern (your index of suspicion) about the presence of serious pathology
- Decide on your clinical action.
This is determined based on your level of concern determined in step 1
- Consider the pathway for emergency/ urgent referral.
This is specific to your local referral pathways. Definitely know your pathways!
Throughout the rest of the framework you are taken step by step through the decision making process for Cauda Equina Syndrome, Spinal Fractures, Spinal Malignancy and Spinal Infections. Each section contains risk factors, signs & symptoms and intial investigations for each of the pathologies listed. These include questions for you to use in clinical practice and the context patients may report the symptoms. It will also highlight key diagnostic physical assessment tools for you to to judge your level of suspicion. Following this you are taken through case studies putting this all together to solidify your understanding.
The level of detail used throughout this framework is exceptional and this framework is firmly in the must read category for all clinicians regardless of your speciality and background. One of the key contributors to the framework is Laura Finucane who has an excellent course available on Physioplus for you to complete at any time. This makes a irresistible combination to cement your knowledge . The link to the course is below with a little bit more about what to expect.