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Table 2 Red flags endorsed for specific disease

From: Red flags presented in current low back pain guidelines: a review

Condition Red flag Endorsed by guideline
Malignancy History of malignancies/cancer Australia, Canada, Finland, France, Germany, Italy, Netherlands, United Kingdom, United States
(Unexplained/unintentional) Weight loss Australia, Canada, Finland, France, Germany, Italy, Netherlands
Pain
    (Increasing) Pain at night Finland, Germany, Italy, Netherlands
    (Continuous) Pain at rest Australia, Italy, Netherlands
    At multiple sites Australia
    Over 1 month (duration) Finland
    Pain at night that is not eased by a prone position (or increasing in supine position) Germany
Failure to improve with treatment (>4–6 weeks) Australia, Canada, France, Italy
Age
    Age over 50 years Australia, France, Italy, Netherlands
    Old age Germany, United Kingdom
Elevated erythrocyte sedimentation (ESR) Netherlands
General malaise Netherlands
Multiple cancer risk factors United States
Strong clinical suspicion United States
Reduced appetite Germany
Rapid fatigue Germany
Progressive symptoms Finland
Fever Finland
Paraparesis Finland
Age over 50 (over 65), first episode of severe back pain [and history of cancer/carcinoma in the last 15 years, unexplained weight loss, failure of conservative care (4 weeks)] Canada
Fracture (History of) Major/significant trauma Australia, Canada, Finland, France, Germany, Italy, Netherlands, United States
(Systemic) Use of steroids Canada, Finland, France, Germany, Italy, Netherlands, United Kingdom
Osteoporosis Finland, Italy, United States
Female gender Italy, Netherlands, United Kingdom
Age
    Age >50 Canada, Finland
    Age >60 Netherlands
 Older age (over 70) France, Italy, United Kingdom
Pain
    Sudden onset Canada
    Loading pain Italy
Minor trauma Germany
Fracture in history/previous fractures Italy
Low body weight Netherlands
Increased thoracic kyphosis Netherlands
Structural deformity Canada
Minor trauma (if age >50, history of osteoporosis and taking corticosteroids) Australia
Severe onset of pain (with minor trauma, age >50, prolonged steroid intake or structural deformity) Canada
Infection Fever ≥38 °C Australia, France, Germany, Italy, United States
Use of corticosteroids or immunosuppressant therapy Australia, Finland, France, Germany, Italy, United States
Intravenous drug abuse/drug addiction Finland, France, Germany, Italy, United States
Immunodeficiency/AIDS Italy, United Kingdom
Urinary tract infection Finland, France, United States
Pain
    Pain with recrudescence at night France
    Intense night pain (and rest pain) Germany, Italy, United States
    Bone tenderness over the lumbar spinous process Australia
Previous back surgery Finland, Germany
Previous bacterial infections Germany, Italy
Penetrating wound Australia
Reduced appetite Germany
Rapid fatigue Germany
Impaired immune system United Kingdom
Underlying disease process Australia
Cauda equina syndrome (CES) Saddle anesthesia/perineal numbness Canada, Europe, Finland, France, Italy, New Zealand, United States
(Sudden onset) Bladder dysfunction (e.g. urinary retention, overflow incontinence) Canada, Europe, Finland, France, Italy, New Zealand, United States
Sphincter disturbance/reduced tonus Canada, Europe, Finland, France, Italy, New Zealand
Progressive weakness in lower limbs/lower motor neuron weakness Europe, Finland, United States
(Wide) Spread sensory deficit (in lower limbs) Italy, New Zealand
Gait disturbance/abnormality Europe, New Zealand
Fecal incontinence Canada, New Zealand
Pain (radiating) in both legs Canada, Italy
Sciatica France