Malignancy history in low back pain a red flag for cancer

The systematic review of 14 studies showed that among 53 ‘red flags’ in patients presenting with low back pain, including age, unexplained weight loss and neurological symptoms, only a history of cancer predicted malignancy.

A history of cancer predicted malignancy with 7% probability in primary care and 33% probability in the emergency setting.

The study, conducted by the George Institute for Global Health at the University of Sydney, also showed that spinal fracture in patients with low back pain was predicted only by older age, with a probability of 9%, prolonged use of corticosteroids (33%), severe trauma (11%) and presence of contusion or abrasion (62%).

The authors said many red flags in current guidelines provided virtually no change in probability of fracture or malignancy or had untested diagnostic accuracy and some guidelines recommended referral for imaging of any red flag was present.

“If this advice was