Red flags to screen for malignancy and fracture in patients with low back pain: systematic review
The objective of the article is to review the evidence on diagnostic accuracy of red flag signs and symptoms in patients with LBP. The study reviewed 14 articles and a total of 53 red flags. Five of the included studies evaluated combinations of red flags. Of these 53 red flags, the 29 were flags to screen for fractures and 24 screened for malignancy.
The review finds that many of the red flags have poor or untested diagnostic accuracy in general. The review suggests that in the case of red flags for fracture older age, prolonged steroid use, severe trauma and contusion or abrasion increased the probability of fracture between 10 and 33%. The presence of multiple red flags increased the probability of between 42% and 90%.
As for the red flags for malignancy -”history of cancer” increased the probability between 7% and 33%. Unexplained weight loss and failure to improve less than one month had probabilities below 3%.
The article therefore adds to the knowledge know that there is a need to screen for fracture and malignancy, but it is yet to be shown which red flags or combinations of red flags should be used, especially when the large number of red flags endorsed in clinical guidelines are taken into consideration. > From: Downie et al., BMJ 347 (2013) f7095.