Professor Murtagh lists the following items as red flags, which, if present, demand extra attention. I’ve added severe pain to this list. RASCAL FACTS WIN is a mnemonic.
- Representation or failure to improve
- Acute onset
- Severe pain
- Cancer hx
- Altered bowel/urine habit, vomiting, dysphagia
- Loss of Weight
- Fever > 37.8
- Age > 50
- Cognitive changes and neurological deficits
- Travel Hx (overseas)
- Syncope on the toilet
- White appearance (Pallor)
- Immunocompromised, i.e. steroids, biologicals, methotrexate, carbimazole
- Narcotics, IVDU, drug or alcohol abuse
Oncological Red Flags
- Loss of weight
- Night sweats
- New lumps or swelling
- Unexplained bleeding or discharge
Neurological Red Flags
- Sudden severe headache
- Changes in mental status
- Sudden vision changes
- Weakness or numbness on one side of the body
Respiratory Red Flags
- Difficulty breathing or rapid breathing
- Blue tint to lips or face (cyanosis)
- Persistent cough with blood (hemoptysis)
Cardiovascular Red Flags
- Chest pain or discomfort
- Shortness of breath
- Palpitations
- Sudden swelling of the legs or ankles
Gastrointestinal Red Flags
- Severe abdominal pain
- Blood in the stool or black, tarry stools
- Jaundice
- Persistent vomiting or diarrhea
Urological Red Flags
- Severe flank pain
- Blood in urine (hematuria)
- Inability to urinate with a full bladder
Musculoskeletal Red Flags
- Severe back pain
- Sudden severe joint pain and swelling
Paediatric Red Flags
Pediatric red flags are warning signs that may indicate a serious underlying condition in a child. These signs necessitate prompt evaluation and intervention. Here are some key pediatric red flags categorized by system:
General
- Failure to thrive: Poor weight gain, weight loss, or growth retardation.
- Lethargy: Significant decrease in energy or responsiveness.
- Inconsolable crying: Persistent, high-pitched, or inconsolable crying.
- Fever: Especially if it is prolonged, recurrent, or associated with other serious symptoms.
Neurological
- Seizures: New onset or recurrent seizures.
- Altered mental status: Confusion, unresponsiveness, or significant changes in behaviour or consciousness.
- Bulging fontanelle: In infants, this can indicate increased intracranial pressure.
- Headache: Severe, recurrent, or associated with neurological deficits.
Respiratory
- Respiratory distress: Rapid breathing, use of accessory muscles, or cyanosis.
- Stridor: High-pitched sound when breathing, indicating upper airway obstruction.
- Persistent cough: Especially if associated with fever, weight loss, or poor feeding.
Cardiovascular
- Cyanosis: Bluish discolouration of the skin, indicating poor oxygenation.
- Heart murmur: New or changing murmur, especially if associated with symptoms like syncope or chest pain.
- Poor perfusion: Cool extremities, delayed capillary refill, or hypotension.
Gastrointestinal
- Vomiting: Persistent, bilious (green), or projectile vomiting.
- Diarrhea: Severe or prolonged diarrhea, especially if associated with dehydration.
- Abdominal pain: Severe, persistent, or localized pain, especially if associated with guarding or rigidity.
Musculoskeletal
- Limping: Persistent or unexplained limping.
- Joint swelling: Swelling, redness, or warmth of joints.
- Bone pain: Persistent or severe bone pain, especially at night or with fever.
Skin
- Rash: Non-blanching, petechial, or purpuric rash.
- Jaundice: It is especially dangerous if it appears within the first 24 hours of life or persists beyond the first two weeks.
Developmental
- Regression: Loss of previously acquired skills.
- Delayed milestones: Significant delay in achieving developmental milestones.
Genitourinary
- Anuria: Lack of urine output.
- Hematuria: Blood in the urine.
Behavioural
- Autism spectrum disorder signs: Lack of eye contact, not responding to name, or loss of social and communication skills.
- Significant changes in behaviour: Sudden changes in mood or personality, extreme anxiety, or aggression.