Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
Br J Sports Med. 2019 May;53(10):648-654. doi: 10.1136/bjsports-2018-099525. Epub 2018 Oct 18.
(1) Describe the evolution of guideline-endorsed red flags for fracture in patients presenting with low back pain; (2) evaluate agreement between guidelines; and (3) evaluate the extent to which recommendations are accompanied by information on diagnostic accuracy of endorsed red flags.
Systematic review.
MEDLINE and PubMed, PEDro, CINAHL and EMBASE electronic databases. We also searched in guideline databases, including the and .
Evidence-based clinical practice guidelines.
Two review authors independently extracted the following data: health professional association or society producing guideline, year of publication, the precise wording of endorsed red flag for vertebral fracture, recommendations for diagnostic workup if fracture is suspected, if the guidelines substantiate the recommendation with citation to a primary diagnostic study or diagnostic review, if the guideline provides any diagnostic accuracy data.
78 guidelines from 28 countries were included. A total of 12 discrete red flags were reported. The most commonly recommended red flags were older age, use of steroids, trauma and osteoporosis. Regarding the evolution of red flags, older age, trauma and osteoporosis were the first red flags endorsed (in 1994); and previous fracture was the last red flag endorsed (in 2003). Agreement between guidelines in endorsing red flags was only fair; kappa=0.32. Only 9 of the 78 guidelines substantiated their red flag recommendations by research and only nine provided information on diagnostic accuracy.
SUMMARY/CONCLUSION: The number of red flags endorsed in guidelines to screen for fracture has risen over time; most guidelines do not endorse the same set of red flags and most recommendations are not supported by research or accompanied by diagnostic accuracy data.
(1) 描述在出现腰痛的患者中，经指南认可的骨折“红色标志”的演变过程；(2) 评估指南之间的一致性；(3) 评估推荐建议是否附有已认可的“红色标志”的诊断准确性信息。
系统评价。
MEDLINE 和 PubMed、PEDro、CINAHL 和 EMBASE 电子数据库。我们还在指南数据库中进行了搜索，包括 和 。
基于证据的临床实践指南。
两位综述作者独立提取了以下数据：制定指南的健康专业协会或学会、出版年份、经指南认可的骨折“红色标志”的确切措辞、怀疑骨折时的诊断性检查建议、如果指南引用初级诊断研究或诊断性综述来支持推荐建议、如果指南提供任何诊断准确性数据。
纳入了来自 28 个国家的 78 条指南。共报告了 12 个离散的“红色标志”。最常推荐的“红色标志”是年龄较大、使用类固醇、外伤和骨质疏松症。关于“红色标志”的演变，年龄较大、外伤和骨质疏松症是最早被认可的“红色标志”（1994 年）；而先前骨折是最后被认可的“红色标志”（2003 年）。指南在认可“红色标志”方面的一致性仅为中等；kappa=0.32。在 78 条指南中，只有 9 条指南通过研究证实了其“红色标志”推荐，只有 9 条指南提供了诊断准确性信息。
总结/结论：指南中用于筛查骨折的“红色标志”数量随着时间的推移而增加；大多数指南不认可同一组“红色标志”，大多数推荐建议没有研究支持，也没有附有诊断准确性数据。
