Which “Red Flags” Portend Risk for Spinal Malignancy or Fracture in Patients with Low Back Pain?

Which history and physical examination “red flags” are useful for identifying patients with low back pain who are at excess risk for spinal malignancy or fracture? To answer this question, researchers conducted a systematic review of 14 studies (9 related to malignancy, 8 related to fracture, and 3 related to both). Eight studies were from primary care, and six were from secondary or tertiary care.

Prevalence of malignancy and fracture varied according to setting; prevalence of malignancy ranged from 0.2% to 7.0%, and fracture prevalence ranged from 1.8% to 9.1%. Twenty-four different red flags were evaluated to screen for malignancy, and 29 were evaluated to screen for fracture. For malignancy, “history of cancer” had the highest post-test …