STarT Back Screening Tool

Refer to these definitions and descriptors as you complete the Essential Assessment Questions

Types of wounds:

Venous ulcer ?, Arterial ulcer ?, Pressure ulcer ?, Diabetic/neuropathic ulcer ?, Burn/blister wound ?

Anatomical location
Wound dimensions:

Length x width x depth in centimeters
(Head to toe = Length, Side to side = width, Straight down = depth)

View Diagram

Undermining & tunneling

View Diagram

Extent of tissue loss:

Non-pressure ulcers: full or partial loss
Pressure ulcers: staging

Tissue present: type and percentage of each present

Granulating (red granular base)

Clean, non-granulating

Hypertrophic Granulation (overgrowth of granulation tissue, sits above skin level)

Slough

Eschar

Epithelial (pink epithelium)

Exudate: type and amount present

Serous, Sanguineous, Serosanguineous, Tan, Yellow, Brown, Green, Clear (thick or thin), Purulent

Oder after cleaning with NS/wound cleanser/water
Wound edges:

Open vs. Closed/Rolled

Distinct vs. indistinct

Periwound skin:

Macerated (white or grey “water-logged” skin)

Intact
Erythema
Candida
Epidermal stripping

ABI Value	Interpretation	Recommendation
Greater than 1.4	Calcification/vessel hardening	Refer to vascular specialist
1.0 - 1.4	Normal	None
0.9 - 1.0	Acceptable	None
0.8 - 0.9	Some arterial disease	Treat risk factor
0.5 - 0.8	Moderate arterial disease	Refer to vascular specialist
Less than 0.5	Severe arterial disease	Refer to vascular specialist

Red Flag	Concerning Dx	Next Steps
Fever, chills, rigors IV drug use Recent infection	Epidural abscess Osteomyelitis Discitis	Stat MRI or transport to ED
History of cancer, new onset of pain Unexplained weight loss Pain not reproducible	Cancer	X-Ray Sed rate, CRP studies MRI w/o labs
Urinary retention/ incontinence Fecal incontinence Motor deficits at multiple levels Perineal numbness Saddle anesthesia Decreased anal sphincter tone	Cauda equine syndrome	Stat Lumbar MRI or transport to ED
Recent severe trauma or less sever trauma with history of osteoporosis, use of corticosteroids and older age Extreme pain with movement	Vertebral compression fracture	Plain film X-Ray or CT

A collaboration of radiology groups throughout Rochester agreed to include a Radiology Epidemiologic Statement with every MRI of the Lumbar Spine report. This table shows the percentage of asymptomatic patients of a particular age range that have that finding on MRI. This begins to put into perspective how common these findings are and how necessary it is to look at these findings in the context of the clinical situation. Showing the patient the prevalence of findings on an MRI, helps define the clinical relevance of the findings and helps set expectations for treatment.

Among patients in the following age groups who are asymptomatic, a lumbar spine MRI will find about...
	20-30 years old	30-40 years old	40-50 years old	50-60 years old	60-70 years old	70-80 years old	80+ years old
Disc Degeneration	37%	52%	68%	80%	88%	93%	96%
Oisc Signal Loss	17%	33%	54%	73%	86%	94%	97%
Disc Height Loss	24%	34%	45%	56%	67%	76%	76%
Disc Bulge	30%	40%	50%	60%	69%	77%	84%
Disc Protrusion	29%	31%	33%	36%	38%	40%	43%
Annular Fissure	19%	20%	22%	23%	25%	27%	29%
Facet Degeneration	4%	9%	18%	32%	50%	69%	83%
Spondylolisthesis	3%	5%	8%	14%	23%	35%	50%

Reference: AJNR Am J Neuroradiol. 2015 April ; 36(4): 811–816. doi:10.3174/ajnr.A4173

The Keele STarT Back Screening Tool

Total Score (all 9):

Sub-Score (5-9):

Reference Documents

STarT Back Screening Tool

The Keele STarT Back Screening Tool

Total Score (all 9):

Sub-Score (5-9):

Reference Documents

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