Back pain is the most common musculoskeletal complaint that results in visits to the ED.
It has a benign course in more than 90% of patients, so we must be vigilant and comfortable looking for warning signs of a neurologically impairing or life-threatening cause.
We rely on the presence of so-called "red flags" or alarm symptoms to guide further diagnostic tests, specialty evaluation, and treatment.
Additionally, always consider 2 important extra-spinal causes of back pain: aortic dissection (sudden onset back pain) and abdominal aortic aneurysm (patients >50, esp. those who you think have a kidney stone- isolated back and groin pain is a common presentation).
History and Physical Examination Red Flags
Historical Red Flags
Physcial Red Flags
Age under 18 or over 50 Pain lasting more than 6 weeks History of cancer Fever and chills Night sweats, unexplained weight loss Recent bacterial infection Unremitting pain despite rest and analgesics Night pain Intravenous drug users, immunocompromised Major trauma Minor trauma in the elder
Fever Writhing in pain Bowel or bladder incontinence Saddle anesthesia Decreased or absent anal sphincter tone erianal or perineal sensory loss Severe or progressive neurologic defect Major motor weakness
