title: Prevalence and "Red Flags" Regarding Specified Causes of Back Pain in Older Adults Presenting in General Practice.
abstract: BACKGROUND
  In a small proportion of patients experiencing unspecified back pain, a specified underlying pathology is present.
  
  
  OBJECTIVE
  The purposes of this study were: (1) to identify the prevalence of physician-specified causes of back pain and (2) to assess associations between "red flags" and vertebral fractures, as diagnosed by the patients' general practitioner (GP), in older adults with back pain.
  
  
  METHODS
  The Back Complaints in the Elders (BACE) study is a prospective cohort study. Patients (aged >55 years) with back pain were included when consulting their GP. A questionnaire was administered and a physical examination and heel bone densitometry were performed, and the results determined back pain and patient characteristics, including red flags. Participants received a radiograph, and reports were sent to their GP. The final diagnoses established at 1 year were collected from the GP's patient registry.
  
  
  RESULTS
  Of the 669 participants included, 6% were diagnosed with a serious underlying pathology during the 1-year follow-up. Most of these participants (n=33, 5%) were diagnosed with a vertebral fracture. Multivariable regression analysis showed that age of ≥75 years, trauma, osteoporosis, a back pain intensity score of ≥7, and thoracic pain were associated with a higher chance of getting the diagnosis of a vertebral fracture. Of these variables, trauma showed the highest positive predictive value for vertebral fracture of 0.25 (95% confidence interval=0.09, 0.41) and a positive likelihood ratio of 6.2 (95% confidence interval=2.8, 13.5). A diagnostic prediction model including the 5 red flags did not increase these values.
  
  
  CONCLUSIONS
  Low prevalence of vertebral fractures could have led to findings by chance.
  
  
  CONCLUSIONS
  In these older adults with back pain presenting in general practice, 6% were diagnosed with serious pathology, mainly a vertebral fracture (5%). Four red flags were associated with the presence of vertebral fracture.
authors.affiliation: W.T.M. Enthoven, MD, Department of General Practice, Erasmus MC, University Medical Center, Post Box 2040, 3000 CA Rotterdam, the Netherlands. w.enthoven@erasmusmc.nl.
authors.forename: Wendy T M
authors.initials: WT
authors.lastname: Enthoven
authors.affiliation: J. Geuze, MD, Department of General Practice, Erasmus MC, University Medical Center.
authors.forename: Judith
authors.initials: J
authors.lastname: Geuze
authors.affiliation: J. Scheele, PhD, Department of General Practice, Erasmus MC, University Medical Center.
authors.forename: Jantine
authors.initials: J
authors.lastname: Scheele
authors.affiliation: S.M.A. Bierma-Zeinstra, PhD, Department of General Practice and Department of Orthopaedics, Erasmus MC, University Medical Center.
authors.forename: Sita M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
authors.affiliation: H.J. Bueving, MD, PhD, Department of General Practice, Erasmus MC, University Medical Center.
authors.forename: Herman J
authors.initials: HJ
authors.lastname: Bueving
authors.affiliation: A.M. Bohnen, MD, PhD, Department of General Practice, Erasmus MC, University Medical Center.
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Bohnen
authors.affiliation: W.C. Peul, MD, PhD, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Peul
authors.affiliation: M.W. van Tulder, PhD, Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, the Netherlands.
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
authors.affiliation: M.Y. Berger, MD, PhD, Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
authors.affiliation: B.W. Koes, PhD, Department of General Practice, Erasmus MC, University Medical Center.
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.affiliation: P.A.J. Luijsterburg, PhD, Department of General Practice, Erasmus MC, University Medical Center.
authors.forename: Pim A J
authors.initials: PA
authors.lastname: Luijsterburg
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000453:epidemiology* / Q000209:etiology*; D004185:Disability Evaluation; D005260:Female; D058006:General Practice; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010147:Pain Measurement; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000150:complications* / Q000175:diagnosis*; D011795:Surveys and Questionnaires