Background In a small proportion of patients experiencing unspecified back pain, a specified underlying pathology is present.
Objective The purposes of this study were: (1) to identify the prevalence of physician-specified causes of back pain and (2) to assess associations between “red flags” and vertebral fractures, as diagnosed by the patients' general practitioner (GP), in older adults with back pain.
Methods The Back Complaints in the Elders (BACE) study is a prospective cohort study. Patients (aged >55 years) with back pain were included when consulting their GP. A questionnaire was administered and a physical examination and heel bone densitometry were performed, and the results determined back pain and patient characteristics, including red flags. Participants received a radiograph, and reports were sent to their GP. The final diagnoses established at 1 year were collected from the GP's patient registry.
Results Of the 669 participants included, 6% were diagnosed with a serious underlying pathology during the 1-year follow-up. Most of these participants (n=33, 5%) were diagnosed with a vertebral fracture. Multivariable regression analysis showed that age of ≥75 years, trauma, osteoporosis, a back pain intensity score of ≥7, and thoracic pain were associated with a higher chance of getting the diagnosis of a vertebral fracture. Of these variables, trauma showed the highest positive predictive value for vertebral fracture of 0.25 (95% confidence interval=0.09, 0.41) and a positive likelihood ratio of 6.2 (95% confidence interval=2.8, 13.5). A diagnostic prediction model including the 5 red flags did not increase these values.
Limitations Low prevalence of vertebral fractures could have led to findings by chance.
Conclusions In these older adults with back pain presenting in general practice, 6% were diagnosed with serious pathology, mainly a vertebral fracture (5%). Four red flags were associated with the presence of vertebral fracture.
Ms Enthoven, Dr Scheele, Professor Bierma-Zeinstra, Dr Bohnen, Dr van Tulder, Professor Peul, Professor Berger, Professor Koes, and Dr Luijsterburg provided concept/idea/research design. Ms Enthoven and Ms Geuze provided writing. Ms Enthoven, Ms Geuze, Dr Scheele, and Dr Luijsterburg provided data collection. Ms Enthoven, Ms Geuze, and Dr Luijsterburg provided data analysis. Ms Enthoven, Professor Bierma-Zeinstra, Dr Bohnen, Dr Bueving, Professor Koes, and Dr Luijsterburg provided project management. Professor Bierma-Zeinstra, Professor Koes, and Dr Luijsterburg provided fund procurement. Professor Bierma-Zeinstra and Dr Bueving provided facilities/equipment. Ms Geuze, Dr Scheele, Professor Bierma-Zeinstra, Dr Bohnen, Dr Bueving, Dr van Tulder, Professor Peul, Professor Berger, Professor Koes, and Dr Luijsterburg provided consultation (including review of manuscript before submission).
The Medical Ethics Committee of Erasmus University Medical Center, Rotterdam, the Netherlands, approved the study protocol.
The study was funded by the Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands, and the Coolsingel Foundation, Rotterdam, the Netherlands. This study also was partly funded by a program grant from the Dutch Arthritis Foundation.
- Received November 29, 2014.
- Accepted July 5, 2015.
- © 2016 American Physical Therapy Association