Cochrane Library

TLDR: The use of “red flags” to guide decisions about the need for further investigation of suspected vertebral fracture in patients presenting with low-back pain is unfounded, and an updated review provides mixed relief for people with diabetes suffering from foot ulcers.

Abstract: The use of “red flags” (specific information from the clinical history and examination used as sentinels of disease) to guide decisions about the need for further investigation of suspected vertebral fracture in patients presenting with low-back pain is unfounded. That’s the discouraging conclusion of the latest diagnostic test accuracy review. The authors looked at eight studies and found that many red flags have high falsepositive rates. The limited evidence makes recommending specific red flags a challenge, but three (older age, significant trauma and corticosteroid use) were more promising, and combinations of red flags were more informative than individual tests (doi: 10.1002/14651858.CD008643.pub2). The primary prevention of cardiovascular disease comes under the spotlight in one new and one updated review. Selenium supplementation is aggressively marketed in some quarters, but the evidence from a new review of 12 studies involving nearly 20 000 participants does not support its use, especially in populations with adequate selenium status. Furthermore, the authors are cautious not to rule out the possibility of an increased risk of type 2 diabetes from taking selenium-only supplements (doi: 10.1002/14651858.CD009671. pub2). More definitive is the evidence to support the use of statins in people at low risk of cardiovascular disease. This comes from an updated review that now includes data on 57 000 participants from 18 randomised trials. Statins reduced major vascular events as well as all-cause mortality. Added bonuses were the absence of serious harms and the likelihood that statins are cost-effective (doi: 10.1002/14651858.CD004816.pub5). An updated review provides mixed relief for people with diabetes suffering from foot ulcers. Non-removable, pressure-relieving casts heal ulcers more effectively than removable casts or dressings alone, but this comes at the price of restricted movement and a possible decrease in quality of life (doi: 10.1002/14651858.CD002302.pub2). Hiccups are a passing nuisance for most of us, but spare a thought for the few who suffer from persistent or intractable hiccups (defined as lasting for more than 48 hours and more than 1 month, respectively). Unfortunately, there’s little relief in sight, since the four poor-quality trials reviewed all investigated treatment with acupuncture and showed that it may be no better than placebo (doi: 10.1002/14651858.CD008768.pub2). Find these and other new and updated reviews this month in The Cochrane Library at www.thecochranelibrary.com. From The Cochrane Library