RED FLAGS FOR LOW BACK PAIN ARE NOT ALWAYS REALLY RED: A PROSPECTIVE EVALUATION OF THE CLINICAL UTILITY OF COMMONLY USED SCREENING QUESTIONS FOR LOW BACK PAIN

BACKGROUND & OBJECTIVE

Red flag questions have long been utilized in clinical practice as a way to identify potential serious underlying spinal pathology as a cause of low back pain, despite limited evidence. This study set out to examine the effectiveness of red flag questions as a screening tool for patients presenting with low back pain to a multidisciplinary academic spine center.

METHODS

Questionnaires which included several red flag questions were completed during their first physician visit among patients who presented as a new patient with a chief complaint of low back pain with or without leg pain. A total of 9,940 patients were included into the study between 2005 and 2016 by a fellowship-trained physician. Diagnostic data (including imaging reports) for the same clinical episode were collected from medical records, and a retrospective review was conducted of the cases of ‘red flag diagnoses’ and the association with red flag screening questions. In this study, spinal fracture, malignancy, infection, and cauda equina syndrome were identified as 'red flag diagnoses'.

RESULTS

Red flags are commonly identified in the low back pain population with 92.6% of the patients possessing at least 1 red flag symptom. Red flag diagnosis was identified in 8.3% of the patients with fracture (5.6%) the most common followed

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