什么是预测背部疼痛为骨折或者恶性肿瘤的真正危险信号？
原作者： Michael Bond，江利冰 翻译, 文章来源： 《中华急诊医学杂志》编辑部 发布日期：2014-12-18

Title: What are the real Red Flags of Back pain that predict fracture or malignancy
题目：什么是预测背部疼痛为骨折或者恶性肿瘤的真正危险信号？
Author 作者: Michael Bond
翻译：江利冰 校对：肖锋

A recent meta-analysis of 14 studies looked at the typical red flags of back pain to see which ones actually truly increase the risk that the patient will have a fracture or malignancy.
最近的一个纳入14项研究荟萃分析，调查了在背部疼痛的危险信号中，哪些真正增加了患者发生骨折或者恶性肿瘤的风险。

The typical historical red flags that are taught are:
典型病史中的危险信号包括：

•Age under 18 or over 50
•年龄小于18岁或者大于50岁
•Pain lasting more than 6 weeks
•背部持续疼痛6周以上
•History of cancer
•癌症病史
•Fever and chills
•发热寒颤
•Night sweats, unexplained weight loss
•盗汗，难以解释的体重减轻
•Recent bacterial infection
•新近发生的细菌感染
•Unremitting pain despite rest and analgesics
•尽管处于休息状态或者使用镇痛药，疼痛均无法中断
•Night pain
•夜晚疼痛
•Intravenous drug users
•吸毒者
•Immunocompromised
•免疫功能低下
•Major trauma
•严重创伤
•Minor trauma in the elderly
•老年患者的轻微创伤

And physical exam red flags are
体格检查中的危险信号包括
•Fever
•发热
•Writhing in pain
•剧烈疼痛
•Bowel or bladder incontinence
•大便和膀胱失禁
•Saddle anesthesia
•鞍部麻木
•Decreased or absent anal sphincter tone
•肛门括约肌功能减退或消失
•Perianal or perineal sensory loss
•肛周或者会阴部感觉消失
•Severe or progressive neurologic defect
•严重或者进展性的神经功能障碍
•Major motor weakness
•严重的运动功能减弱

However, this meta-analysis showed that the only red flags that actually increased the risk of fracture or malignancy were:
但是该荟萃分析显示这些危险信号中真正增加骨折和恶性肿瘤风险的只包括：

•Older Age  Post test Probability 9% (95% CI 3% to 25%)
•高龄 验后概率为9%(95% 置信区间 3%至 25%)
•Prolonged corticosteroid use Post test Probability 33% (95% CI 10% to 67%)
•长期的激素使用史 验后概率为33% (95% 置信区间10% 至 67%)
•Severe trauma Post test Probability 11% (95% CI 8 % to 16%)
•严重的创伤 验后概率为11% (95% 置信区间8 % 至16%)
•Presence of contusion or abrasion Post test Probability 62% (95% CI 49% to 74%)
•存在挫伤或擦伤 验后概率为62% (95% 置信区间49% 至 74%)

So this study highlights that a lot of the red flags that we have learned do not actually increase the risk fracture or malignancy, although some like fever, IVDA, and immunocomproromised increase the risk of epidural abscesses, which was not addressed in this meta-analysis.
因此该研究强调了我们所了解的危险信号中，很多并不真正增加骨折和恶性肿瘤的发生率，尽管一些如发热、吸毒以及免疫功能低下等危险信号会增加硬膜外脓肿的发生，但是这一内容并没有在该荟萃分析中讨论。

The take home point for me is that plain radiographs/CT scans are probably only needed in patients with older age, prolonged corticosteroid use, severe trauma or presence o contusion or abrasion. If you are really worried about others with back pain just proceed directly to MRI as the plain films/CT scans are not going to be very helpful.
 总结一下，只有高龄、长时间使用激素、严重创伤或者存在挫伤或擦伤的患者需要进行平片或者CT扫描。如果你真的担心其他的背部疼痛的患者，请直接开具核磁共振检查（MRI），因为这时平片或者CT扫描没有多大的帮助。

References 参考文献
Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain. British Journal of Sports Medicine. 2014;48(20):1518–1518. doi:10.1136/bjsports-2014-f7095rep.