Red Flag Conditions
These conditions are potentially life-threatening and include:
Infection
Malignancy
Non-accidental injury
NICE Guidance is available to aid clinical assessment and management of red flag conditions which can present with musculoskeletal features. These include;
Features that suggest severe life threatening conditions:
Sepsis
- Complete non-weight bearing
- Pseudo-paralysis of limb
- Any attempt to passively move the limb is resisted and causes extreme distress
- Pain severe and non-remitting
- Limb held in a position which accommodates increased joint volume due to effusion, e.g.hip held in external rotation
- Night pain and waking
- Fever
- Immunocompromised child - due to primary disease or medications
- Back pain in the unwell child
Malignancy
- Night pain
- Pain severe and non-remitting
- Bone pain
- Pallor
- Bruising
- Lymphadenopathy
- Hepatosplenomegaly
- Anaemia, thrombocytopenia
- Systemic symptoms (lethargy, weight loss, night sweats, fever)
- Complete non-weight bearing
- Back pain in the unwell child
- Weight loss
Non-accidental injury
- Delay in seeking medical attention
- History inconsistent with pattern of injury
- Explanation of injury incongruent with developmental stage of child
- Repeated presentations
- Un-witnessed injury
- Patterns of injury suggestive of non-accidental injury (e.g. bruising over soft tissue areas, multiple bruises, bruises that carry the imprint of an instrument or implement)
- Distinctive burns e.g. round cigarette burn, forced immersion burn
- Complete non-weight bearing with occult fracture
- Type of fracture e.g. metaphyseal
- Multiple injuries
- Unkempt appearance and poor hygiene