Red eyes and red-flags: improving ophthalmic assessment and referral in primary care

Back pain has been reported as a common cause for various patients to present in an emergency or primary care settings. Besides, the management of back pain has been associated with a huge economic burden and remarkably impacts the quality of life of the affected patients. The diagnosis of acute low-back pain can be adequately achieved by conducting proper clinical evaluation and knowing the characteristics of each condition. The present review discusses the clinical evaluation and red flags for diagnosing patients presenting with acute low-back pain. An adequate examination of patients is conducted by obtaining a thorough history and successful physical examination. It should be noted that obtaining an adequate history might not be enough in some cases, and physical examination might not show any diagnostic clues. However, we also reported various red flags for detecting serious conditions, including malignancy, infections, inflammation, and others. These might help establish a further assessment of these patients, including imaging and laboratory studies. Therefore, these cases should be managed as early as possible to enhance the prognosis and intervene against any potential complications.

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Triage bei Kopfschmerz in der Hausarztpraxis: Wann einweisen?

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0759-8052 ◽

2019 ◽

Vol 144 (10) ◽

pp. 651-658

Author(s):

Solveig Carmienke ◽

Dagny Holle-Lee

Keyword(s):

Primary Care ◽

Emergency Department ◽

General Practitioner ◽

Hospital Care ◽

Secondary Headache ◽

Red Flags ◽

Secondary Headaches ◽

Specialist Treatment ◽

Yellow Flags ◽

Headache Patients

AbstractHeadache is one of patients’ most common reasons to consult their general practitioner and covers about 2 – 5 % of the consultations in primary care. Often, the general practitioner is the first to be contacted by patients with headache. Mostly, headaches are primary and only 2 % of the patients have secondary headaches. The distinction between primary and secondary headache is the most important step in the management of patients with headache in primary care. Therefore, this article shows important elements of anamnesis and examination of headache patients in primary care. Furthermore, this article focuses on identification of red flags and yellow flags in the consultation of patients with headache and suggests recommendations for referral to emergency department, hospital care or specialist treatment.

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Red eyes in children: red flags and a case to learn from

British Journal of General Practice ◽

10.3399/bjgp16x688309 ◽

2016 ◽

Vol 66 (653) ◽

pp. 633-634

Author(s):

Paul G Rainsbury ◽

Kate Cambridge ◽

Stephen Selby ◽

Jonathan Lochhead

Keyword(s):

Red Flags ◽

Red Eyes

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Serious pathology in people presenting to primary care with acute low back pain is rare (0.9%), but high false-positive rates for some 'red flags' may limit their diagnostic value

Evidence-Based Medicine ◽

10.1136/ebm1040 ◽

2010 ◽

Vol 15 (2) ◽

pp. 61-62

Author(s):

R. F. McLain

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

False Positive ◽

Diagnostic Value ◽

Low Back ◽

Red Flags ◽

Acute Low Back Pain

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Genetic red flags: clues to thinking genetically in primary care practice

Primary Care Clinics in Office Practice ◽

10.1016/j.pop.2004.04.010 ◽

2004 ◽

Vol 31 (3) ◽

pp. 497-508 ◽

Cited By ~ 10

Author(s):

Alison J. Whelan ◽

Susie Ball ◽

Lyle Best ◽

Robert G. Best ◽

Susan C. Echiverri ◽

...

Keyword(s):

Primary Care ◽

Primary Care Practice ◽

Care Practice ◽

Red Flags

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Management of Laryngopharyngeal Reflux: A Practical Algorithm Management for Primary care Physicians

10.20944/preprints202010.0364.v1 ◽

2020 ◽

Author(s):

Jerome R Lechien ◽

Sven Saussez ◽

Vinciane Muls ◽

Maria R Barillari ◽

Carlos M. Chiesa-Estomba ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physician ◽

Primary Care Physicians ◽

Laryngopharyngeal Reflux ◽

Mouth Opening ◽

Care Physician ◽

Red Flags ◽

Patient Reported ◽

Practical Algorithm ◽

Primary Care Medicine

Laryngopharyngeal reflux (LPR) is a prevalent disease in the general population and may have acute or chronic clinical presentation. LPR may be misdiagnosed in primary care medicine regarding the lack of gastroesophageal reflux disease symptoms and the lack of findings at the gastrointestinal endoscopy. Depending on the physician field of expertise and experience, LPR may be clinically over- or under-diagnosed. The management of LPR is possible in primary care medicine but primary care physician has to consider some red flags that requires to address the patient to otolaryngologist or gastroenterologist. The use of patient-reported outcome questionnaire such as reflux symptom score-12 and the consideration of some oral and pharyngeal findings visualized through the mouth opening may help the primary care physician to evaluate the LPR findings at the diagnosis time and throughout treatment. In this review, we provide a practical algorithm of management of LPR for primary care physician or other specialists that cannot perform fiberoptic examination. In this algorithm, physician has to exclude some confounding conditions such as allergy or other causes of pharyngolaryngitis and red flags. Physician may prescribe an empirical treatment based on diet and behavioral changes with or without medication, depending on the complaint severity of the patient. In case of prescription of medication, proton pump inhibitors and alginate have to be considered in association to protect the upper aerodigestive tract mucosa from acid, weakly acid and alkaline pharyngeal reflux events.

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Acute red eye in children: A practical approach

Australian Journal of General Practice ◽

10.31128/ajgp-02-20-5240 ◽

2020 ◽

Vol 49 (12) ◽

pp. 815-822

Author(s):

Siyuan Jabelle Lu ◽

Graham A Lee ◽

Glen A Cole

Keyword(s):

General Practice ◽

General Practitioner ◽

Wide Spectrum ◽

Practical Approach ◽

History Taking ◽

Red Flags ◽

Red Eye ◽

Urgent Referral ◽

Red Eyes

Background Acute red eye in a child is a common ocular presentation in general practice. It can arise from a wide spectrum of pathologies and involve various ocular structures. Objective The aim of this article is to provide a framework for the general practitioner to assess and manage a child presenting with a red eye, with a focus on cases that require immediate referral. Discussion Most paediatric red eyes are benign and can be safely managed in general practice. However, this requires thorough history-taking and examination together with the ruling out of red flags. Assessment of a child with a red eye may pose specific challenges that can usually be overcome by focused history-taking and opportunistic examination. Urgent referral for examination under sedation or anaesthesia is indicated when there is suspicion of a vision-threatening cause and/or assessment in the clinic is unsuccessful.

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Red Flags in Geriatric Medicine: Assessing Risk and Managing It in Primary Care

Practical Issues in Geriatrics - The Role of Family Physicians in Older People Care ◽

10.1007/978-3-030-78923-7_14 ◽

2022 ◽

pp. 221-240

Author(s):

Erik Lagolio ◽

Ilaria Rossiello ◽

Andreas Meer ◽

Vania Noventa ◽

Alberto Vaona

Keyword(s):

Primary Care ◽

Geriatric Medicine ◽

Red Flags

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A Qualitative Study of Increased Pediatric Reutilization After a Postdischarge Home Nurse Visit

Journal of Hospital Medicine ◽

10.12788/jhm.3370 ◽

2020 ◽

Vol 15 (9) ◽

pp. 518-525 ◽

Cited By ~ 1

Author(s):

Sarah W Riddle ◽

Susan N Sherman ◽

Margo J Moore ◽

Allison M Loechtenfeldt ◽

Heather L Tubbs-Cooley ◽

...

Keyword(s):

Primary Care ◽

Focus Groups ◽

Primary Care Physicians ◽

Home Visit ◽

Controlled Trial ◽

Hospital Medicine ◽

Warning Sign ◽

Red Flags ◽

Hospital To Home ◽

Home Nurse

BACKGROUND: The Hospital to Home Outcomes (H2O) trial was a 2-arm, randomized controlled trial that assessed the effects of a nurse home visit after a pediatric hospital discharge. Children randomized to the intervention had higher 30-day postdischarge reutilization rates compared with those with standard discharge. We sought to understand perspectives on why postdischarge home nurse visits resulted in higher reutilization rates and to elicit suggestions on how to improve future interventions. METHODS: We sought qualitative input using focus groups and interviews from stakeholder groups: parents, primary care physicians (PCP), hospital medicine physicians, and home care registered nurses (RNs). A multidisciplinary team coded and analyzed transcripts using an inductive, iterative approach. RESULTS: Thirty-three parents participated in interviews. Three focus groups were completed with PCPs (n = 7), 2 with hospital medicine physicians (n = 12), and 2 with RNs (n = 10). Major themes in the explanation of increased reutilization included: appropriateness of patient reutilization; impact of red flags/warning sign instructions on family’s reutilization decisions; hospital-affiliated RNs “directing traffic” back to hospital; and home visit RNs had a low threshold for escalating care. Major themes for improving design of the intervention included: need for improved postdischarge communication; individualizing home visits—one size does not fit all; and providing context and framing of red flags. CONCLUSION: Stakeholders questioned whether hospital reutilization was appropriate and whether the intervention unintentionally directed patients back to the hospital. Future interventions could individualize the visit to specific needs or diagnoses, enhance postdischarge communication, and better connect patients and home nurses to primary care.

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