PT  - JOURNAL ARTICLE
AU  - Chad E Cook
AU  - Steven Z George
AU  - Michael P Reiman
TI  - Red flag screening for low back pain: nothing to see here, move along: a narrative review
AID  - 10.1136/bjsports-2017-098352
DP  - 2018 Apr 01
TA  - British Journal of Sports Medicine
PG  - 493--496
VI  - 52
IP  - 8
4099  - http://bjsm.bmj.com/content/52/8/493.short
4100  - http://bjsm.bmj.com/content/52/8/493.full
SO  - Br J Sports Med2018 Apr 01; 52
AB  - 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. We 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; and (4) clinical practice guidelines do not include specific processes that aid decision-making. Based on these findings, we propose that clinicians consider: (1) the importance of watchful waiting; (2) the value-based care does not support clinical examination driven by red flag symptoms; and (3) the recognition that red flag symptoms may have a stronger relationship with prognosis than diagnosis.