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Traditional teaching and guidelines hold that patients with low back pain require further evaluation (including imaging) if their histories reveal so-called “red flags.” In this retrospective study, researchers examined the predictive accuracy of red-flag questions for identifying serious disorders among nearly 10,000 patients (mean age, 57) with low back pain who completed questionnaires (which included red-flag items) at initial visits to a university orthopedics spine practice. Serious disorders — fracture, malignancy, infection, or cauda equina syndrome —eventually were diagnosed in 8% of patients.
A positive response to a red-flag question increased the likelihood of a serious diagnosis only modestly. Moreover, negative responses did no…