Red flags in medical practice

Welch, Ellen

doi:10.7861/clinmedicine.11-3-251

Cited by 11 publications

(8 citation statements)

References 10 publications

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“…However, some of these disease entities may exhibit unusual signs highly suggestive of a particular disease, which may serve as “red flag” signs to guide the work-up including the choice of paraclinical tests. Although the concept of red flags is intuitive for physicians ( 12 ), only one article explicitly applies it to the etiologic diagnosis of chorea syndromes ( 13 ). In addition, the specific paraclinical tests deemed necessary are sometimes unaffordable or inaccessible.…”

Section: Introductionmentioning

confidence: 99%

Combining Literature Review With a Ground Truth Approach for Diagnosing Huntington's Disease Phenocopy

Nguyen

Ortigoza‐Escobar

Burgunder³

et al. 2022

Front. Neurol.

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One percent of patients with a Huntington's disease (HD) phenotype do not have the Huntington (HTT) gene mutation. These are known as HD phenocopies. Their diagnosis is still a challenge. Our objective is to provide a diagnostic approach to HD phenocopies based on medical expertise and a review of the literature. We employed two complementary approaches sequentially: a review of the literature and two surveys analyzing the daily clinical practice of physicians who are experts in movement disorders. The review of the literature was conducted from 1993 to 2020, by extracting articles about chorea or HD-like disorders from the database Pubmed, yielding 51 articles, and analyzing 20 articles in depth to establish the surveys. Twenty-eight physicians responded to the first survey exploring the red flags suggestive of specific disease entities. Thirty-three physicians completed the second survey which asked for the classification of paraclinical tests according to their diagnostic significance. The analysis of the results of the second survey used four different clustering algorithms and the density-based clustering algorithm DBSCAN to classify the paraclinical tests into 1st, 2nd, and 3rd-line recommendations. In addition, we included suggestions from members of the European Reference Network-Rare Neurological Diseases (ERN-RND Chorea & Huntington disease group). Finally, we propose guidance that integrate the detection of clinical red flags with a classification of paraclinical testing options to improve the diagnosis of HD phenocopies.

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Section: Introductionmentioning

confidence: 99%

Combining Literature Review With a Ground Truth Approach for Diagnosing Huntington's Disease Phenocopy

Nguyen

Ortigoza‐Escobar

Burgunder³

et al. 2022

Front. Neurol.

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“…Specifically, we found that clinicians indicated they would order neuroimaging 67.1% of the time in scenarios with red flags that have limited evidence to support their use. The use of “red flags” to identify underlying medical conditions originated in back pain, 31,32 but has been extended to a number of settings, 33 including other neurologic conditions, such as Parkinson’s disease 34 and cauda equina syndrome 35 . In conditions other than headache, systematic reviews typically find that red flags result in low sensitivity and a high false positive rate 31,34,35 .…”

Section: Discussionmentioning

confidence: 99%

Headache neuroimaging: A survey of current practice, barriers, and facilitators to optimal use

et al. 2022

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Objective The objective of this study was to understand current practice, clinician understanding, attitudes, barriers, and facilitators to optimal headache neuroimaging practices. Background Headaches are common in adults, and neuroimaging for these patients is common, costly, and increasing. Although guidelines recommend against routine headache neuroimaging in low‐risk scenarios, guideline‐discordant neuroimaging is still frequently performed. Methods We administered a 60‐item survey to headache clinicians at the Veterans Affairs health system to assess clinician understanding and attitudes on headache neuroimaging and to determine neuroimaging practice patterns for three scenarios describing hypothetical patients with headaches. Descriptive statistics were used to summarize responses, stratified by clinician type (physicians or advanced practice clinicians [APCs]) and specialty (neurology or primary care). Results The survey was successfully completed by 431 of 1426 clinicians (30.2% response rate). Overall, 317 of 429 (73.9%) believed neuroimaging was overused for patients with headaches. However, clinicians would utilize neuroimaging a mean (SD) 30.9% (31.7) of the time in a low‐risk scenario without red flags, and a mean 67.1% (31.9) of the time in the presence of minor red flags. Clinicians had stronger beliefs in the potential benefits (268/429, 62.5%) of neuroimaging compared to harms (181/429, 42.2%) and more clinicians were bothered by harms stemming from the omission of neuroimaging (377/426, 88.5%) compared to commission (329/424, 77.6%). Additionally, APCs utilized neuroimaging more frequently than physicians and were more receptive to potential interventions to improve neuroimaging utilization. Conclusions Although a majority of clinicians believed neuroimaging was overused for patients with headaches, many would utilize neuroimaging in low‐risk scenarios with a small probability of changing management. Future studies are needed to define the role of currently used red flags given their importance in neuroimaging decisions. Importantly, APCs may be an ideal target for future optimization efforts.

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“…Sometimes, as the telehealth consult progresses, it becomes evident that the patient's reason for consulting a clinician is of a complexity that exceeds the telehealth context. 9 This situation should prompt the clinician to consider if there is a need for further assistance in their patient's care in some other manner, such as moving to a face-to-face consult or seeking a second opinion from a specialist, peer or supervisor.…”

Section: Final Thoughtsmentioning

confidence: 99%

Telehealth: An area that aligns with general practitioners’ expertise

Butel¹

2021

Aust J Gen Pract

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Red flags in medical practice

Abstract: Oral feeding diffi culties and dilemmasA guide to practical care, particularly towards the end of life 10% discount for fellows and membersQuote the reference Clinical Medicine when making your order

Cited by 11 publications

References 10 publications

Combining Literature Review With a Ground Truth Approach for Diagnosing Huntington's Disease Phenocopy

Combining Literature Review With a Ground Truth Approach for Diagnosing Huntington's Disease Phenocopy

Headache neuroimaging: A survey of current practice, barriers, and facilitators to optimal use

Telehealth: An area that aligns with general practitioners’ expertise

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