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Serious Pathology Uncommon in Low Back Pain Patients

Recommended 'red flag' screening questions may identify only half of serious cases

THURSDAY, Oct. 15 (HealthDay News) -- In patients presenting to primary care settings with acute low back pain, previously undiagnosed serious spinal pathology is rare, and commonly asked "red flag" screening questions may not identify it, according to a study in the October issue of Arthritis & Rheumatism.

Nicholas Henschke, Ph.D., of the University of Sydney in Australia, and colleagues studied 1,172 patients who were asked 25 red-flag questions at an initial consultation and given an initial diagnosis.

The researchers found that only 11 patients (0.9 percent) had serious spinal pathology, eight of whom had a fracture. Although 80.4 percent of all patients had at least one red flag, only five of the 11 serious cases were identified at an initial consultation, and six false-positive diagnoses were made. The researchers also found that only three red flags recommended for fracture were useful: prolonged use of corticosteroids, age above 70 years, and significant trauma.

"Some red flags have very high false-positive rates, indicating that, when used in isolation, they have little diagnostic value in the primary care setting," the authors conclude.

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