Are self-employed musculoskeletal physiotherapists mis-diagnosing Cauda Equina syndrome? A retrospective study of clinical negligence claims in the UK

Physiotherapy ◽  
2017 ◽  
Vol 103 ◽  
pp. e78-e79
Author(s):  
N. Beswetherick
Keyword(s):  
Retrospective Study ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
The Uk

Evaluation of Nationwide Referral Pathways, Investigation and Treatment of Suspected Cauda Equina Syndrome in the United Kingdom (ENTICE)

Neurosurgery ◽  
2019 ◽  
Vol 84 (5) ◽  
pp. E271-E271 ◽  
Author(s):  
Dillon Vyas ◽  
Keyword(s):  
United Kingdom ◽  
Cauda Equina Syndrome ◽  
Clinical Symptoms ◽  
Cauda Equina ◽  
National Guidelines ◽  
Time Intervals ◽  
Mri Scan ◽  
Out Of Hours ◽  
The United Kingdom ◽  
The Uk

Abstract INTRODUCTION Cauda equina syndrome (CES) is a spinal emergency with clinical symptoms and signs that have low diagnostic accuracy. National guidelines in the United Kingdom (UK) state that all patients should undergo an MRI prior to referral to specialist spinal units and surgery, if required, should be performed at the earliest opportunity. We aimed to evaluate the current practice of investigating and treating suspected CES in the UK. METHODS A retrospective, multicentre observational study of the investigation and management of patients with suspected CES was conducted across the UK, including all patients referred to a spinal unit over 6 mo between 1st October 2016 and 31st March 2017. RESULTS A total of 28 UK spinal units submitted data on 4441 referrals. Over half of the referrals were made without any previous imaging (n = 2572, 57.9%). The majority of referrals were made out-of-hours (n = 2229/3517, 63.4%), of which 2.9% (n = 45/1529) underwent surgical decompression. Patient location and prereferral imaging were not significantly associated with time intervals from symptom onset or presentation to decompression. Patients investigated outside of the spinal unit experienced significantly longer time intervals from presentation and from referral to undergoing the MRI scan. CONCLUSION This is the largest known study of the investigation and management of suspected CES. We found that the majority of referrals were made without adequate investigations. Most patients were referred out-of-hours and many were transferred for an MRI without subsequently requiring surgery. Cases not transferred experienced delays if undergoing an MRI scan outside of the spinal unit.

scholarly journals The Value of Interhospital Transfer and Emergency MRI for Suspected Cauda Equina Syndrome: A 2-Year Retrospective Study

2008 ◽  
Vol 90 (6) ◽  
pp. 513-516 ◽  
Author(s):  
M Crocker ◽  
G Fraser ◽  
E Boyd ◽  
J Wilson ◽  
BP Chitnavis ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Pain Syndrome ◽  
Working Hours ◽  
Out Of Hours ◽  
Interhospital Transfer ◽  
Mri Scans ◽  
Prolapsed Intervertebral Disc ◽  
Magnetic Resonance Imaging Mri ◽  
The Uk

INTRODUCTION The timing of surgery in cauda equina syndrome due to prolapsed intervertebral disc remains controversial. Assessment of these patients requires magnetic resonance imaging (MRI), which is of limited availability outside normal working hours in the UK. PATIENTS AND METHODS We reviewed radiological results in all patients undergoing emergency MRI within our unit for suspected cauda equina syndrome over a 2-year period, and all subjects undergoing emergency lumbar discectomy for cauda equina syndrome within the same period. Outcome measures were: proportion of positive findings in symptomatic patients and proportion of patients referred with diagnostic MRI scans undergoing emergency surgery. We also assessed outcomes of patients having surgery for cauda equina syndrome in terms of improvement of pain, sensory and sphincter disturbance. RESULTS A total of 76 patients were transferred for assessment and ‘on-call’ MRI; 27 were subsequently operated upon. Only 5 proceeded to emergency discectomy that night (prior to next scheduled list). This may be due to delays in timing – from referral to acceptance, to arrival in the department, to diagnostic scan and to theatre. With the second group of patients, 43 had emergency discectomy for cauda equina syndrome during the study period. Of these, 6 patients had an out-of-hours MRI at our hospital for assessment (one patient living locally). Most surgically treated patients experienced improvement in their pain syndrome, with approximately two-thirds experiencing improvement in sensory and sphincter disturbance. CONCLUSIONS These data support a policy of advising MRI scan for cauda equina syndrome at the earliest opportunity within the next 24 h in the referring hospital, rather than emergency transfer for diagnostic imaging which has a relatively low yield in terms of patients operated on as an emergency.

scholarly journals Understanding cauda equina syndrome: protocol for a UK multicentre prospective observational cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e025230 ◽  
Author(s):  
Julie Woodfield ◽  
Ingrid Hoeritzauer ◽  
Aimun A B Jamjoom ◽  
Savva Pronin ◽  
Nisaharan Srikandarajah ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cauda Equina Syndrome ◽  
Management Practices ◽  
Cauda Equina ◽  
National Standards ◽  
Standards Of Care ◽  
Limb Weakness ◽  
Study Results ◽  
Patient Reported ◽  
The Uk

IntroductionCauda equina syndrome (CES) is a potentially devastating condition caused by compression of the cauda equina nerve roots. This can result in bowel, bladder and sexual dysfunction plus lower limb weakness, numbness and pain. CES occurs infrequently, but has serious potential morbidity and medicolegal consequences. This study aims to identify and describe the presentation and management of patients with CES in the UK.Methods and analysisUnderstanding Cauda Equina Syndrome (UCES) is a prospective and collaborative multicentre cohort study of adult patients with confirmed CES managed at specialist spinal centres in the UK. Participants will be identified using neurosurgical and orthopaedic trainee networks to screen referrals to spinal centres. Details of presentation, investigations, management and service usage will be recorded. Both patient-reported and clinician-reported outcome measures will be assessed for 1 year after surgery. This will establish the incidence of CES, current investigation and management practices, and adherence to national standards of care. Outcomes will be stratified by clinical presentation and patient management. Accurate and up to date information about the presentation, management and outcome of patients with CES will inform standards of service design and delivery for this important but infrequent condition.Ethics and disseminationUCES received a favourable ethical opinion from the South East Scotland Research Ethics Committee 02 (Reference: 18/SS/0047; IRAS ID: 233515). All spinal centres managing patients with CES in the UK will be encouraged to participate in UCES. Study results will be published in medical journals and shared with local participating sites.Trial registration numberISRCTN16828522; Pre-results.

scholarly journals 1436 A Stab in The Back: Assessment of Suspected Cauda Equina Syndrome by The Emergency Department Prior To Referral to Orthopaedics in A District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Hyett ◽  
N Campbell ◽  
O Olukoya
Keyword(s):  
Emergency Department ◽  
Neurological Examination ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
District General Hospital ◽  
Delayed Treatment ◽  
Clinical Notes ◽  
Bladder Scan ◽  
Cord Injury ◽  
The Uk

Abstract Introduction Within the UK, Cauda Equina Syndrome (CES) is a rare surgical emergency which has the potential to cause significant morbidity. Within hospitals that do not have an on-site neurosurgical service, assessment of potential CES patients is performed in the Emergency Department (ED) prior to referral to either local orthopaedic or regional neurosurgical services. Delay or inefficiency in this assessment can result in delayed treatment and worsens patient outcomes. Method A retrospective study with patients identified from the orthopaedic trauma meeting lists over a 6-month period. Only patients assessed by the emergency department were included (25 total). Direct referrals and those with infective symptoms were excluded. ED clinical notes were assessed, and the documentation was compared against a standard from the American Spinal Cord Injury Association. Documentation of pre- and post-void bladder scan was also assessed. Results Of the 25 total patients, 60% had a full lower limb neurological examination documented. 20% had no documented neurological examination and 20% had an incomplete neurological examination. Only 68% of patients had a Per Rectal exam performed, of those 94% had perianal sensation assessed. 56% of patients did not have a post-void bladder scan documented. Conclusions Limitations to initial ED assessment of likely CES patients can delay diagnosis and treatment which can have devastating consequences for the patient. The data is limited by reliance on an accurate trauma list and exclusion of patients who were referred directly to neurosurgery from ED. Our recommendations include introduction of a CES assessment proforma within ED and a re-audit cycle.

scholarly journals The clinical features and outcome of scan-negative and scan-positive cases in suspected cauda equina syndrome: a retrospective study of 276 patients

2018 ◽  
Vol 265 (12) ◽  
pp. 2916-2926 ◽  
Author(s):  
Ingrid Hoeritzauer ◽  
Savva Pronin ◽  
Alan Carson ◽  
Patrick Statham ◽  
Andreas K. Demetriades ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Features ◽  
Cauda Equina Syndrome ◽  
Cauda Equina

scholarly journals A scoping review protocol: Investigating the extent and legal process of cauda equina syndrome claims for UK physiotherapists

2021 ◽  
Author(s):  
Rachel L. Leech ◽  
James Selfe ◽  
Suzanne Ball ◽  
Susan Greenhalgh ◽  
Gareth Hogan ◽  
...  
Keyword(s):  
Scoping Review ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Legal Process ◽  
Review Protocol

scholarly journals Bilateral triceps surae muscle focal myositis after a cauda equina syndrome

2021 ◽  
Author(s):  
G.R. González Toledo ◽  
H. Pérez Pérez ◽  
L. Brage Martín ◽  
V. Castro López-Tarruella
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Triceps Surae ◽  
Triceps Surae Muscle

scholarly journals Acute bilateral foot drop with or without cauda equina syndrome—a case series

2021 ◽  
Vol 163 (4) ◽  
pp. 1191-1198
Author(s):  
Andreas K. Demetriades ◽  
Marco Mancuso-Marcello ◽  
Asfand Baig Mirza ◽  
Joseph Frantzias ◽  
David A. Bell ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Case Series ◽  
Foot Drop ◽  
Spinal Disease ◽  
Full Resolution ◽  
Degenerative Spinal Disease ◽  
The Mean ◽  
The One

Abstract Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h. Three had concomitant cauda equina syndrome; of these, the first two made a full motor recovery, one by 6 weeks follow-up and the second on the same-day post-op evaluation. Overall, five out of seven cases had full resolution of their ankle dorsiflexion pareses. One patient with 1/5 power has not improved. Another with 1/5 weakness improved to normal on the one side and to 3/5 on the other. Conclusion When bilateral foot drop occurs acutely, we encourage the consideration of degenerative spinal disease. Relevant discopathy was observed from L2/3 to L5/S1; aberrant innervation may be at play. Cauda equina syndrome is not necessarily associated with acute bilateral foot drop. The prognosis seems to be pretty good with respect to recovery of the foot drop, especially if partial at presentation and if treated within 48 h.

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