Red flags to screen for malignancy and fracture in patients with low back pain

Aron Downie; Christopher M Williams; Nicholas Henschke; Mark J Hancock; Raymond W J G Ostelo; Henrica C W de Vet; Petra Macaskill; Les Irwig; Maurits W van Tulder; Bart W Koes; Christopher G Maher

doi:10.1136/bjsports-2014-f7095rep

Red flags to screen for malignancy and fracture in patients with low back pain

Br J Sports Med. 2014 Oct;48(20):1518. doi: 10.1136/bjsports-2014-f7095rep.

Authors

Affiliations

¹ George Institute for Global Health, University of Sydney, Sydney, NSW, 2050, Australia Faculty of Science, Macquarie University, Sydney, Australia.
² George Institute for Global Health, University of Sydney, Sydney, NSW, 2050, Australia.
³ George Institute for Global Health, University of Sydney, Sydney, NSW, 2050, Australia Institute of Public Health, University of Heidelberg, Germany.
⁴ Faculty of Human Sciences, Macquarie University, Sydney, Australia.
⁵ Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, Amsterdam, Netherlands.
⁶ Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam.
⁷ Screening and Test Evaluation Program (STEP), School of Public Health, Sydney.
⁸ School of Public Health, University of Sydney, Sydney, Australia.
⁹ Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands.
¹⁰ Department of General Practice, Erasmus Medical Centre, Rotterdam, Netherlands.

PMID: 25257627
DOI: 10.1136/bjsports-2014-f7095rep

Abstract

Study question: What are the best red flags to indicate the possibility of fracture or malignancy in patients presenting with low back pain in primary, secondary, or tertiary care?

Summary answer: Older age, prolonged corticosteroid use, severe trauma, and presence of a contusion or abrasion increase the likelihood of spinal fracture (likelihood was higher with multiple red flags); a history of malignancy increases the likelihood of spinal malignancy.

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