Screening for Referral

Screening for “Red Flags” is a useful process in the physical therapy setting.  Red flags can help a physical therapist identify patient symptoms that require immediate attention, further screening, or referral to another practitioner. The presence of one red flag in isolation typically does not warrant urgent medical attention, but a cluster of three or more flags present at the same time should raise concern. The following is a list of major red flags that, in combination, may indicate systemic pathology.

•       History of cancer (personal or family)

•       Recent infection (past 6 weeks)

•       Recurrent colds or flu

•       History of trauma

•       History of immunosuppression (i.e. steroids, organ transplant, HIV)

•       Insidious onset of pain

•       Significant weight loss or gain (without effort)

•       Pain unrelieved by rest or change in position

•       Symptoms are out of proportion to the injury

•       Unable to reproduce the symptoms during the exam

•       Symptoms do not fit the expected mechanical or neuromusculoskeletal pattern

•       Bilateral symptoms

•       Poorly localized pain

•       Night pain

•       Change in bowel and bladder (loss of control, constipation, diarrhea)

•       Recent change in medication

•       Presence of constitutional symptoms

•       Proximal muscle weakness (esp with changes in DTR’s)

•       Pain or symptoms that do not improve with physical therapy intervention

 

 

 

Reference:

Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists: Screening for Referral. Fourth ed. St. Louis: Saunders, Elsevier Inc.; 2007.