History

Presenting features

Back pain context

OPQRST

Pain characterization

Neuro and functional baseline

Neurologic symptoms and function

Symptom trajectory and prior episodes

Pattern and comparisons

Alarm Features

Immediate threats

Time critical escalation triggers

Vital sign danger thresholds

High risk vital patterns

High risk historical triggers

High risk exposures and events

High risk exam findings

Medications

Immunosuppression and infection risk drugs

Medications increasing infection risk

Analgesics and masking of fever

Medications affecting presentation

Antimicrobials and culture effects

Recent antimicrobials

Anticoagulants and procedure risk

Hemorrhage and neuraxial considerations

Diet

Intake and hydration

Recent intake status

Alcohol and substance exposures

Exposures influencing risk

Diabetes related intake patterns

Glycemic risk context

Review of Systems

Infectious and inflammatory symptoms

Systemic symptoms

Neurologic symptoms

Cardiopulmonary symptoms

Genitourinary and abdominal symptoms

GU and abdominal symptoms

Collateral History and Family History

Collateral sources

Source and reliability

Family history relevant to infection risk

Family history and inherited risks

Exposure context

Household and community context

Risk Factors

Spinal infection risk factors

Predisposition and exposures

Bacteremia sources

Potential bacteremia source

Procedure and device related risks

Procedure and device risks

Special populations

Population based risk amplifiers

Differential Diagnosis

Life threatening

Cannot miss diagnoses

Common

Common alternatives

Less common

Important less common diagnoses

Mimics and pitfalls

Mimics that delay diagnosis

Past Medical History

Infection history

Prior infections and colonization

Spine history

Baseline spine conditions

Immunocompromise comorbidities

Conditions increasing risk

Baseline function

Functional baseline

Physical Exam

General and vitals

General status

Spine and back exam

Back and spine findings

Neurologic exam

Neurologic assessment

Abdominal and genitourinary exam

Abdominal and GU findings

Skin and cardiovascular exam

Source clues

Lab Studies

Core labs

Initial laboratory evaluation

Microbiology

Culture strategy

Interpretation pearls

Inflammatory marker interpretation

Special populations and safety labs

Safety and comorbidity labs

Imaging

Scoring Systems

Decision support framing

MRI

Preferred imaging

MRI considerations

CT

Alternative imaging pathways

CT limitations

Ultrasound

Bedside and targeted ultrasound

Ultrasound limitations

Special Tests

Bedside tests

Bedside adjuncts

Procedures and sampling

Diagnostic procedures when indicated

Avoidances and pitfalls

ECG

Indications

ECG use cases in this presentation

High risk findings

ECG red flags

Assessment

Working diagnosis framing

Spinal infection concern severity

Severity and risk stratification

High risk features present

Complications to rule out

Complications

Diagnostic uncertainty handling

Alternate diagnoses tracking

Plan

First 5 minutes

Immediate stabilization workflow

Diagnostic sequencing

Diagnostic plan

Empiric antimicrobials

Empiric antibiotic strategy

Pain control

Analgesia plan

Consultation

Consultation triggers

Monitoring and reassessment loop

Reassessment loop

Disposition

Level of care

ICU criteria

Admission criteria

Inpatient admission indications

Transfer criteria

Transfer to higher level care

Discharge criteria

Discharge only when low suspicion

Discharge Instructions

Copy discharge instructions

Back pain evaluation today did not show signs of a spinal emergency at this time

Medications

Activity

Follow up

References

Guidelines and high quality sources

Evidence sources