Red flags for potential serious pathologies masquerading as musculoskeletal neck pain: a protocol for a systematic review of clinical practice guidelines

BackgroundAlthough benign most of the time, neck pain (NP) has been observed as the early manifestation of various serious cervical pathologies (e.g., malignancies, fractures). Red flags (RF) are signs and symptoms that raise suspicion of serious spinal pathology. Considering that it has been estimated that the incidence of delayed diagnosis of serious cervical pathologies ranges from 5% to 20%, investigating RFs for NP remains a priority for an informed practice and the patients safety. Therefore, the following systematic review will aim to identify red flags recommendations to triage serious pathologies in current clinical practice guidelines (CPGs) for patients with NP, to evaluate the consistency between different CPGs regarding RF recommendations, and to investigate on what study type the recommendation of CPGs are based. Material and methodsWe will search for CPGs for patients with specific or non - specific NP by searching MEDLINE (via PubMed), EMBASE, and PEDro electronic databases. Guidelines will also be searched through forward and backward citation tracking strategies (Web of Science), by consulting experts in the field, and by checking guideline organization databases. Also, we will screen the references of two recently published systematic reviews on CPGs for NP. For all the CPGs included, we will extract bibliographic information, the serious pathologies considered, the RF considered for all serious pathologies, the reference used to support all the RF cited in the guideline, and, if available, the diagnostic accuracy data for all the RF. Two authors will independently perform the study selection and data extraction processes. Data synthesisResults will be presented descriptively and using graphs and tables. We will evaluate the consistency among the guidelines in their endorsement of red flags using Fleiss kappa. Fleiss kappa will be presented separately for all serious pathologies the CPGs consider.