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Red flags presented in current low back pain guidelines: a review

Overview of attention for article published in European Spine Journal, July 2016
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • Among the highest-scoring outputs from this source (#31 of 3,262)
  • High Attention Score compared to outputs of the same age (95th percentile)
  • High Attention Score compared to outputs of the same age and source (98th percentile)

Mentioned by

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74 tweeters
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3 Facebook pages

Citations

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32 Dimensions

Readers on

mendeley
279 Mendeley
Title
Red flags presented in current low back pain guidelines: a review
Published in
European Spine Journal, July 2016
DOI 10.1007/s00586-016-4684-0
Pubmed ID
Authors

Arianne P. Verhagen, Aron Downie, Nahid Popal, Chris Maher, Bart W. Koes

Abstract

The purpose of this study was to identify and descriptively compare the red flags endorsed in guidelines for the detection of serious pathology in patients presenting with low back pain to primary care. We searched databases, the World Wide Web and contacted experts aiming to find the multidisciplinary clinical guideline in low back pain in primary care, and selected the most recent one per country. We extracted data on the number and type of red flags for identifying patients with higher likelihood of serious pathology. Furthermore, we extracted data on whether or not accuracy data (sensitivity/specificity, predictive values, etc.) were presented to support the endorsement of specific red flags. We found 21 discrete guidelines all published between 2000 and 2015. One guideline could not be retrieved and after selecting one guideline per country we included 16 guidelines in our analysis from 15 different countries and one for Europe as a whole. All guidelines focused on the management of patients with low back pain in a primary care or multidisciplinary care setting. Five guidelines presented red flags in general, i.e., not related to any specific disease. Overall, we found 46 discrete red flags related to the four main categories of serious pathology: malignancy, fracture, cauda equina syndrome and infection. The majority of guidelines presented two red flags for fracture ('major or significant trauma' and 'use of steroids or immunosuppressors') and two for malignancy ('history of cancer' and 'unintentional weight loss'). Most often pain at night or at rest was also considered as a red flag for various underlying pathologies. Eight guidelines based their choice of red flags on consensus or previous guidelines; five did not provide any reference to support the choice of red flags, three guidelines presented a reference in general, and data on diagnostic accuracy was rarely provided. A wide variety of red flags was presented in guidelines for low back pain, with a lack of consensus between guidelines for which red flags to endorse. Evidence for the accuracy of recommended red flags was lacking.

Twitter Demographics

The data shown below were collected from the profiles of 74 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 279 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Australia 2 <1%
Portugal 1 <1%
Mexico 1 <1%
United States 1 <1%
Unknown 274 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 59 21%
Other 45 16%
Unspecified 31 11%
Student > Bachelor 30 11%
Student > Postgraduate 24 9%
Other 90 32%
Readers by discipline Count As %
Medicine and Dentistry 132 47%
Nursing and Health Professions 71 25%
Unspecified 42 15%
Sports and Recreations 12 4%
Neuroscience 8 3%
Other 14 5%

Attention Score in Context

This research output has an Altmetric Attention Score of 47. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 24 June 2019.
All research outputs
#350,213
of 13,165,983 outputs
Outputs from European Spine Journal
#31
of 3,262 outputs
Outputs of similar age
#12,083
of 261,178 outputs
Outputs of similar age from European Spine Journal
#2
of 114 outputs
Altmetric has tracked 13,165,983 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 97th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 3,262 research outputs from this source. They receive a mean Attention Score of 3.5. This one has done particularly well, scoring higher than 99% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 261,178 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 95% of its contemporaries.
We're also able to compare this research output to 114 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 98% of its contemporaries.