Red flag screening for low back pain: nothing to see here, move along: a narrative review.

Screening for red flags in individuals with low back pain (LBP) has been a historical hallmark of musculoskeletal management. Red flag screening is endorsed by most LBP clinical practice guidelines, despite a lack of support for their diagnostic capacity. The authors share four major reasons why red flag screening is not consistent with best practice in LBP management.

  1. Clinicians do not actually screen for red flags, they manage the findings
  2. Red flag symptomology negates the utility of clinical findings
  3. The tests lack the negative likelihood ratio to serve as a screen
  4. Clinical practice guidelines do not include specific processes that aid decision-making.

Based on these findings, the authors propose that clinicians consider the importance of watchful waiting and the value-based care does not support clinical examination driven by red flag symptoms; and finally the recognition that red flag symptoms may have a stronger relationship with prognosis than diagnosis.