349 Improving Assessment of Patients with Suspected Cauda Equina Syndrome Using A Standardised Proforma

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Ramasubbu ◽  
R Ahlo ◽  
Q Liao ◽  
K Periasamy
Keyword(s):  
Urinary Incontinence ◽  
Statistical Analysis ◽  
Patient Care ◽  
Faecal Incontinence ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Regional Level ◽  
Standards Of Care ◽  
Chi Squared ◽  
Enhance Patient Care

Abstract Introduction Cauda Equina Syndrome (CES) has a devastating impact on the life of affected individuals. Most patients are reviewed by doctors who do not have specialist spinal expertise. NHS Lanarkshire guidelines for CES are based on ‘Standards of Care in Cauda Equina Syndrome’ (Todd and Dickson) 2016. Method Documented assessment of a sample of patients with suspected CES in our hospital was audited against standards set in regional guidelines. A tick-box proforma was introduced to standardise assessment, with re-audit thereafter. Chi-squared was used for statistical analysis. Results Cycle 1 (2018): Documented assessment of findings in 30 patients - bilateral radiculopathy (80%), urinary incontinence (93%), faecal incontinence (73%), anal tone (93%), saddle anaesthesia (83%), bladder volumes (90%) and ASIA chart (20%). Cycle 2 (2019): Documented assessment of above findings was 100% in patients where a proforma was used. Proforma was used in 81% of patients. Conclusions Use of a standardised proforma improved assessment of CES. There was a statistically significant improvement in use of an ASIA chart (P < 0.01) and assessment of faecal incontinence (P = 0.039). Compliance with use of this proforma could be improved further, to enhance patient care. Following the success of the proforma, it is being reviewed for implementation on a regional level.

Standards of care in cauda equina syndrome

2016 ◽  
Vol 30 (5) ◽  
pp. 518-522 ◽  
Author(s):  
N. V. Todd ◽  
R. A. Dickson
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Standards Of Care

Limited sequence MRI to improve standards of care for suspected cauda equina syndrome

2020 ◽  
Vol 102-B (4) ◽  
pp. 501-505 ◽  
Author(s):  
Ramal Gnanasekaran ◽  
Nicholas Beresford-Cleary ◽  
Tariq Aboelmagd ◽  
Karim Aboelmagd ◽  
Daniel Rolton ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Standards Of Care ◽  
Safety And Efficacy ◽  
Cauda Equina Compression ◽  
Mri Scans ◽  
Symptoms And Signs ◽  
Limited Sequence ◽  
Musculoskeletal Radiologist ◽  
Rule Out

Aims Early cases of cauda equina syndrome (CES) often present with nonspecific symptoms and signs, and it is recommended that patients undergo emergency MRI regardless of the time since presentation. This creates substantial pressure on resources, with many scans performed to rule out cauda equina rather than confirm it. We propose that compression of the cauda equina should be apparent with a limited sequence (LS) scan that takes significantly less time to perform. Methods In all, 188 patients with suspected CES underwent a LS lumbosacral MRI between the beginning of September 2017 and the end of July 2018. These images were read by a consultant musculoskeletal radiologist. All images took place on a 3T or 1.5T MRI scanner at Stoke Mandeville Hospital, Aylesbury, UK, and Royal Berkshire Hospital, Reading, UK. Results The 188 patients, all under the age of 55 years, underwent 196 LS lumbosacral MRI scans for suspected CES. Of these patients, 14 had cauda equina compression and underwent emergency decompression. No cases of CES were missed. Patients spent a mean 9.9 minutes (8 to 10) in the MRI scanner. Conclusion Our results suggest that a LS lumbosacral MRI could be used to diagnose CES safely in patients under the age of 55 years, but that further research is needed to assess safety and efficacy of this technique before changes to existing protocols can be recommended. In addition, work is needed to assess if LS MRIs can be used throughout the spine and if alternative pathology is being considered. Cite this article: Bone Joint J 2020;102-B(4):501–505.

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.

PTH-256 Sns for faecal incontinence following cauda equina syndrome

Gut ◽  
2015 ◽  
Vol 64 (Suppl 1) ◽  
pp. A524.1-A524
Author(s):  
S Elzein ◽  
C Hoh ◽  
S Brown ◽  
C Maxwell-Armstrong
Keyword(s):  
Faecal Incontinence ◽  
Cauda Equina Syndrome ◽  
Cauda Equina

British Association of Spine Surgeons standards of care for cauda equina syndrome

2015 ◽  
Vol 15 (3) ◽  
pp. S2-S4 ◽  
Author(s):  
Timothy Germon ◽  
Sashin Ahuja ◽  
Adrian T.H. Casey ◽  
Nicholas V. Todd ◽  
Am Rai
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
British Association ◽  
Standards Of Care
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