Red flags presented in current low back pain guidelines: a review.
Arianne P Verhagen1, Aron Downie2,3, Nahid Popal4
1Department of General Practice, Erasmus Medical Centre University, PO box 2040, 3000 CA, Rotterdam, The Netherlands. a.verhagen@erasmusmc.nl.
Summary
This study found many different red flags for serious low back pain conditions across international guidelines. However, there was little agreement on which red flags to use and a lack of evidence supporting their accuracy.
Area of Science:
- Medical Guidelines
- Primary Care
- Low Back Pain
Background:
- Low back pain is a common condition presenting to primary care.
- Identifying serious underlying pathology is crucial for appropriate patient management.
- Clinical guidelines aim to standardize the detection of serious conditions through red flags.
Purpose of the Study:
- To identify and compare red flags for serious pathology in low back pain guidelines.
- To assess the evidence supporting the use of these red flags.
Main Methods:
- Systematic search of databases, web, and expert consultation for low back pain guidelines.
- Selection of the most recent guideline per country.
- Extraction of data on red flags and their supporting accuracy evidence.
Main Results:
- Analyzed 16 guidelines from 15 countries and Europe, published 2000-2015.
- Identified 46 distinct red flags across four categories: malignancy, fracture, cauda equina syndrome, and infection.
- Found limited consensus on red flags and rare provision of diagnostic accuracy data.
Conclusions:
- Guidelines present a wide array of red flags for low back pain with considerable variation.
- There is a notable lack of consensus among guidelines regarding recommended red flags.
- Evidence supporting the diagnostic accuracy of endorsed red flags is largely absent.
