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Red flags to screen for malignancy and fracture in patients with low back pain
  1. Aron Downie1,2,
  2. Christopher M Williams1,
  3. Nicholas Henschke1,3,
  4. Mark J Hancock4,
  5. Raymond W J G Ostelo5,
  6. Henrica C W de Vet6,
  7. Petra Macaskill7,
  8. Les Irwig8,
  9. Maurits W van Tulder9,
  10. Bart W Koes10,
  11. Christopher G Maher1
  1. 1George Institute for Global Health, University of Sydney, Sydney, NSW, 2050, Australia
  2. 2Faculty of Science, Macquarie University, Sydney, Australia
  3. 3Institute of Public Health, University of Heidelberg, Germany
  4. 4Faculty of Human Sciences, Macquarie University, Sydney, Australia
  5. 5Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, Amsterdam, Netherlands
  6. 6Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam
  7. 7Screening and Test Evaluation Program (STEP), School of Public Health, Sydney
  8. 8School of Public Health, University of Sydney, Sydney, Australia
  9. 9Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
  10. 10Department of General Practice, Erasmus Medical Centre, Rotterdam, Netherlands
  1. Correspondence to : A Downie, George Institute for Global Health, University of Sydney, PO Box M201, Camperdown, Sydney, NSW, 2050, Australia; adownie{at}


STUDY QUESTION What are the best red flags to indicate the possibility of fracture or malignancy in patients presenting with low back pain in primary, secondary, or tertiary care?

SUMMARY ANSWER Older age, prolonged corticosteroid use, severe trauma, and presence of a contusion or abrasion increase the likelihood of spinal fracture (likelihood was higher with multiple red flags); a history of malignancy increases the likelihood of spinal malignancy.

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