Vertebral Fracture: Likelihood Ratios

Introduction: as a serious cause of back pain. See also Spinal Tumor as another serious cause. Red Flags are supposed to help the clinician distinguish serious from non-serious (strain and/or disc bulge) causes of back pain.

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Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Primary care for acute low back pain	0.9%	Arthritis Rheum. 2009 Oct;60(10):3072-80. PMID: 19790051
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The likelihood ratios of findings for Vertebral Fracture are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] Red Flags	+ 0 -	15.8	0.4
for 2/4 criteria: Age>70 Female Sig Trauma Prolonged steroid use Sens/spec for 1/4 was 88%/50%; for 3/4 was 38%/100% Study: Arthritis Rheum. 2009 Oct;60(10):3072-80. PMID: 19790051
[ + ] Clinical diagnosis	+ 0 -	inf	0.5
Study: Arthritis Rheum. 2009 Oct;60(10):3072-80. PMID: 19790051
[ + ] Age	+ 0 -	12.5	0.5
age > 70 Study: Arthritis Rheum. 2009 Oct;60(10):3072-80. PMID: 19790051

Good Positive Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] History of Corticosteroid Use	+ 0 -	inf	0.8
"prolonged use" Study: Arthritis Rheum. 2009 Oct;60(10):3072-80. PMID: 19790051
[ + ] Trauma	+ 0 -	12.5	0.8
major trauma in adults or minor in elderly Study: Arthritis Rheum. 2009 Oct;60(10):3072-80. PMID: 19790051