A patient may be admitted to A & E complaining of severe back pain and at the same time may also be exhibiting signs and symptoms of cauda equina (Latin for ‘Horses tail‘ as the nerves at the end of the spinal cord resemble a horses tail). Cauda equina is extreme pressure or swelling of the nerves at the end of the spinal cord. If cauda equina is recognised (red flag indicator), it is indicative of the need for urgent referral for Specialist and/or surgical treatments, as opposed to a patient’s complaint which is purely mechanical back pain. Failure on the part of the medical practitioner to identify or act on ‘red flag” indicators can produce adverse results for the patient, which can include permanent paralysis, impaired bladder/bowel control, difficulty walking and other neurological and physical problems i.e. more serious complications. How can understanding these “red, yellow, blue and black flag‘ indicators assist when reading clinical notes or issues surrounding ‘return to work’?
Red and yellow flag indicators are more common than blue or black flag indicators in clinical notes. However, by possessing even a basic understanding of what the various ‘flag’s’ represent, particularly red and yellow flags, it will assist you to identify how practitioners, who are often overworked, or even undertrained hospital nursing staff, inexperienced Registrars or suburban or country GP’s do miss and overlook ‘flag indicators’, which may result in adverse consequences for the patient – your client.
- Red Flags -Red flags are clinical indicators of possible serious underlying pathology requiring further urgent medical intervention. Red flags were designed for use in acute low back pain, but the underlying concept can be applied more broadly in the search for serious underlying pathology in any pain presentation. Its often helpful to be aware of what symptoms and clinical signs of examination findings are indicative of red flags, which, to a competent and experienced medical practitioner should lead to recognition of a potentially more serious condition, requiring referral and emergency care.
- Yellow Flags -Yellow flags can relate to the patient’s attitudes, beliefs, emotions, behaviours, family, judgment and workplace. It is often a reference to fear avoidance behaviour (due to fear of pain if a person engages in X), over reliance on passive treatments, thoughts that the injury is uncontrollable or likely to worsen. Often a predictor of possible or perceived psychological barriers to recovery and delayed return to work.
- Blue Flags -Blue flags can be considered in terms of the employee and the workplace. The employee often has fears and misconceptions about work and health based on their own previous experiences or those of others in the company they work for, or stories from the neighbours. They believe that work is too onerous and likely to cause further injury. Belief that workplace supervisor and workmates are unsupportive.
- Black Flags -There is some overlap between blue and black flags, but they can be primarily distinguished by the black flags being those that are outside the immediate control of the employee and/or the team trying to facilitate the return to work. They include conflict with insurance staff over injury claim and heavy work with little opportunity to modify duties.
If you require the assistance of a medical negligence or personal injury barrister, who through her 15 years employment in medicine can interpret your client’s clinical notes, care and treatments, to ensure the matter is less complicated, please call (02) 9336 5399 or email firstname.lastname@example.org