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What is a clinical red flag? And why should we care about them?

Evaluating clinical red flags minimises missing serious diseases in primary care and practice.

One of the main tasks of a health care practitioner is to marginalise the risk of missing serious underlying diseases that may be present. So what is a red flag? A red flag in plain English can be defined as signs or symptoms that can be found in a patient’s history and/or clinical examination that may tie to a serious pathology. Pathology is a fancy term, it is defined as: The cause and effect of a disease.

A 2018 paper explores the meaning of a red flag, how it can be diagnosed and why it is important to understand the concept.[1] While working in the healthcare space, the practitioner will encounter many different people with all kinds of signs and symptoms. Most of these signs and symptoms are mild, or otherwise harmless – this is actually a good thing as the person is then safe and a good health outcome can be assured.

The broad numbers of disease, infection, illness, and injury requires knowledge to treat individuals within the population. Going back to red flags, a vital role of the health practitioner is to use that broad knowledge to then minimise the risk of that person becoming seriously unwell and being aware of the possibility of a life-threatening disorder.

A good example of something common and yet potentially sinister are headaches. Headaches are among the most common pain problems in health practice. Up to 95% of women and 91% of men experience a headache during a 12 month period with 18% of these women and 15% of these men consulting a professional because of their headache.

Almost all the population, at some point, will experience a headache. The large majority of people’s headaches being what’s called a primary headache. These include migraines, tension type headache and cluster headaches and these are all benign (that is, once diagnosed they are not red flags).

However, even with the large number of headaches being benign there are other headaches indicating a serious disorder underneath. Examples of headaches leading to possible conditions can include a sudden onset ‘thunderclap’ headache, increasing headache frequency or severity, headache with signs of systemic illness (like a high temperature of feeling very unwell), focal neurological signs (such as imbalance, visual problems, and muscle weakness) and headaches following a head trauma.

Other red flags such as rapid weight loss, and backache and simultaneous loss of appetite are general in nature but as a health professional we must be aware of the potential risk they can be a red flag. Being able to recognise this red flag could be the difference of saving someone’s life. Paying attention to the individual and a thorough conduction of a case history gathers all relevant information to decide if the patient should seek further assistance and care for a suspected underlying disorder. Being aware of atypical (AKA unusual) features may suggest another diagnosis. These can include but are not limited to a history of trauma, prolonged morning joint stiffness, rapid worsening of symptoms, persistent night pain, unexplained weight loss and neurological symptoms or signs.

Red flags are a crucial part of primary and all forms of healthcare. The paper will be referenced below for anyone who would like to give it a read.

Finally, what does all this mean for you as a reader? Ensure you are taking care of yourself as best you can, get regular (annual or even bi-annual) check-ups with your family health practitioner and make your own health your priority.

Yours in health,

Tyler Cubby

[1] Ramanayake RPJC, Basnayake BMTK. Evaluation of red flags minimizes missing serious diseases in primary care. J Family Med Prim Care. 2018 Mar-Apr;7(2):315-318. doi: 10.4103/jfmpc.jfmpc_510_15. PMID: 30090770; PMCID: PMC6060920.

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