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Low Back Pain "Red Flags" for Fracture and Malignancy Found Wanting — Physician’s First Watch

Medical News |
December 13, 2013

Low Back Pain "Red Flags" for Fracture and Malignancy Found Wanting

By Joe Elia

Current guidelines on when to screen for fracture or malignancy in patients presenting with low back pain need an overhaul, according to a BMJ review.

The reviewers examined evidence from 14 studies — about half from primary care — and determined pre– and post–diagnostic test probabilities of spinal fracture and malignancy for some 50 red flag signs mentioned in various guidelines.

For spinal fracture, the red flags with the highest post-test probabilities were older age (9%), severe trauma (11%), prolonged corticosteroid use (33%), and the presence of contusions or abrasions (62%). A history of malignancy was the red flag with the highest post-test probability for spinal malignancy (33%).

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