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.
- Clinicians do not actually screen for red flags, they manage the findings
- Red flag symptomology negates the utility of clinical findings
- The tests lack the negative likelihood ratio to serve as a screen
- 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.