Premkumar et al present evidence that the traditional “red flags” for ominous causes of back pain can be quite misleading. The correlation between red flags and ominous diagnoses is poor, and prone to producing false negatives: that is, no red flags even when there is something more serious than unexplained pain going on. In a survey of almost 10,000 patients
the absence of red flag responses did not meaningfully decrease the likelihood of a red flag diagnosis.
This is not even remotely a surprise to anyone who paid attention in back pain school, but it’s good to have some harder data on it.