BACKGROUND: Cauda equina syndrome, a rare but disabling spinal surgical emergency, requires prompt investigation, ideally using magnetic resonance imaging as patients may require decompressive surgery. Out of hours access to magnetic resonance imaging is only routinely available in major trauma centres and neurosurgical units. Patients in regional hospitals with suspected cauda equina syndrome may require transfer for diagnostic imaging. We retrospectively studied the proportion of patients referred with suspected cauda equina syndrome who required out of hours transfer for magnetic resonance imaging and decompressive surgery. MATERIALS ANDS METHODS: Retrospective cohort study of patients referred using online referral platforms with suspected acute cauda equina syndrome and transferred out of hours between 6pm to 8am on weekdays and all day on weekends to two of the largest neurosurgical units in the UK in Birmingham and Cambridge. RESULTS: A total of 441 patients were referred across both sites with a suspicion of acute cauda equina syndrome; 339 patients were transferred for diagnostic scans and only 16 of them (4.7%) were positive for cauda equina compression, necessitating prompt decompressive surgery. Of the patients with negative magnetic resonance scans, 50% had their discharge or transfer back to referring hospitals delayed by more than 24 hours. CONCLUSIONS: Over 95% of patients who were transferred for imaging did not undergo emergency decompression. The authors propose a greater role for the provision of out of hours magnetic resonance imaging in all hospitals admitting emergency patients to streamline management.
BACKGROUND: Cauda equina syndrome, a rare but disabling spinal surgical emergency, requires prompt investigation, ideally using magnetic resonance imaging as patients may require decompressive surgery. Out of hours access to magnetic resonance imaging is only routinely available in major trauma centres and neurosurgical units. Patients in regional hospitals with suspected cauda equina syndrome may require transfer for diagnostic imaging. We retrospectively studied the proportion of patients referred with suspected cauda equina syndrome who required out of hours transfer for magnetic resonance imaging and decompressive surgery. MATERIALS ANDS METHODS: Retrospective cohort study of patients referred using online referral platforms with suspected acute cauda equina syndrome and transferred out of hours between 6pm to 8am on weekdays and all day on weekends to two of the largest neurosurgical units in the UK in Birmingham and Cambridge. RESULTS: A total of 441 patients were referred across both sites with a suspicion of acute cauda equina syndrome; 339 patients were transferred for diagnostic scans and only 16 of them (4.7%) were positive for cauda equina compression, necessitating prompt decompressive surgery. Of the patients with negative magnetic resonance scans, 50% had their discharge or transfer back to referring hospitals delayed by more than 24 hours. CONCLUSIONS: Over 95% of patients who were transferred for imaging did not undergo emergency decompression. The authors propose a greater role for the provision of out of hours magnetic resonance imaging in all hospitals admitting emergency patients to streamline management.
Entities:
Keywords:
Cauda equina syndrome; Magnetic resonance imaging; Neurosurgery; Spinal surgery
Authors: Daniel M Fountain; Simon C L Davies; Julie Woodfield; Mohammed Kamel; Paulina Majewska; Ellie Edlmann; Aimun A B Jamjoom; Ingrid Hoeritzauer; Mueez Waqar; Dominic E Mahoney; Dillon Vyas; Moritz W J Schramm; Georgios Solomou; Francesca E C Dawkes; Heidi K Grant; Jonathan E Attwood; Alexandros Boukas; Dominic J Ballard; Emma Toman; Matthew I Sanders; Beverly Cheserem; Saurabh Sinha; Patrick Statham Journal: Br J Neurosurg Date: 2019 Impact factor: 1.596
Authors: Alex Gitelman; Shuriz Hishmeh; Brian N Morelli; Samuel A Joseph; Andrew Casden; Paul Kuflik; Michael Neuwirth; Mark Stephen Journal: Am J Orthop (Belle Mead NJ) Date: 2008-11
Authors: Anthony Minh Tien Chau; Lileane Liang Xu; Nicholas Robert Pelzer; Cristian Gragnaniello Journal: World Neurosurg Date: 2013-11-13 Impact factor: 2.104