Red flag screening for low back pain: nothing to see here, move along: a narrative review. Issue 8 (18th September 2017)

• Record Type: Journal Article
• Authors: Cook, Chad E; George, Steven Z; Reiman, Michael P
• Is Part Of: British journal of sports medicine. Volume 52:Issue 8(2018)
• Page Start: 493
• Page End: 496
• Publication Date: 2017-09-18
• Subjects: low back pain -- red flags -- orthopaedic -- screening; Sports medicine -- Periodicals; 617.1027
• DOI: 10.1136/bjsports-2017-098352
• Languages: English
• ISSNs: 0306-3674

Abstract

Abstract : Screening for red flags in individuals with low back pain (LBP) has been a historical hallmark of musculoskeletal management. Red flag screening is endorsed by most LBP clinical practice guidelines, despite a lack of support for their diagnostic capacity. We share four major reasons why red flag screening is not consistent with best practice in LBP management: (1) clinicians do not actually screen for red flags, they manage the findings; (2) red flag symptomology negates the utility of clinical findings; (3) the tests lack the negative likelihood ratio to serve as a screen; and (4) clinical practice guidelines do not include specific processes that aid decision-making. Based on these findings, we propose that clinicians consider: (1) the importance of watchful waiting; (2) the value-based care does not support clinical examination driven by red flag symptoms; and (3) the recognition that red flag symptoms may have a stronger relationship with prognosis than diagnosis.