Prevalence of “Red Flags” Among the Internet User with Low Back Pain Seeking Information on Spinal Health—A Web Survey

Background: In early management of low back pain (LBP) the identification of “red flags” (RFs) plays an important role, as this condition is highly prevalent, and advanced treatment would not be feasible in every case. These alarm signs are designed to detect serious causes requiring prompt interventions, such as malignancy, fracture, inflammation, or cauda equina syndrome. Although their predictive value has been questioned, they are commonly used in clinical practice. The use of RFs in Web applications has never been evaluated before. In theory, they should reduce risks related to online counseling on LBP, screening for possible potentially serious underlying conditions based on relatively simple questionnaires. This study was designed to assess the prevalence of RFs among Internet users with LBP seeking information about spinal disorders. Materials and Methods: Of 2,471 respondents who completed the RF questionnaire, 2,349 entries were used for analysis. Of another 1,959 respondents who completed the additional questionnaire containing the Oswestry Disability Scale, data from 1,850 were included in the study. Results: The majority of subjects (68.16%) reported at least one RF. The most prevalent RF was a foot weakness; the least prevalent was unexplained weight loss. Pain intensity was a significant risk factor for presence of at least one RF. Conclusions: The results show that RFs are highly prevalent and that most likely the negative predictive value of RFs will be low. Unfortunately, considering the nature of this study it was impossible to evaluate their sensitivity and specificity. In conclusion, although RFs are highly prevalent in the population studied, simple screening should be mandatory in all Web sites providing information on spinal health. Further research should be undertaken to optimize RFs.