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.

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.

A prospective study of the role of bladder scanning and post-void residual volume measurement in improving diagnostic accuracy of cauda equina syndrome

2020 ◽  
Vol 102-B (6) ◽  
pp. 677-682
Author(s):  
Galateia Katzouraki ◽  
Akbar Jaleel Zubairi ◽  
Oded Hershkovich ◽  
Michael P. Grevitt
Keyword(s):  
Risk Stratification ◽  
Prospective Study ◽  
Clinical Assessment ◽  
Predictive Value ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Cost Savings ◽  
Volume Measurement ◽  
Cauda Equina Compression ◽  
Mri Scans

Aims Diagnosis of cauda equina syndrome (CES) remains difficult; clinical assessment has low accuracy in reliably predicting MRI compression of the cauda equina (CE). This prospective study tests the usefulness of ultrasound bladder scans as an adjunct for diagnosing CES. Methods A total of 260 patients with suspected CES were referred to a tertiary spinal unit over a 16-month period. All were assessed by Board-eligible spinal surgeons and had transabdominal ultrasound bladder scans for pre- and post-voiding residual (PVR) volume measurements before lumbosacral MRI. Results The study confirms the low predictive value of ‘red flag’ symptoms and signs. Of note ‘bilateral sciatica’ had a sensitivity of 32.4%, and a positive predictive value (PPV) of only 17.2%, and negative predictive value (NPV) 88.3%. Use of a PVR volume of ≥ 200 ml was a demonstrably more accurate test for predicting cauda equina compression on subsequent MRI (p < 0.001). The PVR sensitivity was 94.1%, specificity 66.8%, PPV 29.9% and NPV 98.7%. The PVR allowed risk-stratification with 13% patients deemed ‘low-risk’ of CES. They had non-urgent MRI scans. None of the latter scans showed any cauda equina compression (p < 0.006) or individuals developed subsequent CES in the intervening period. There were considerable cost-savings associated with the above strategy. Conclusion This is the largest reported prospective evaluation of suspected CES. Use of the PVR volume ≥ 200 ml was considerably more accurate in predicting CES. It is a useful adjunct to conventional clinical assessment and allows risk-stratification in managing suspected CES. If adopted widely it is less likely incomplete CES would be missed. Cite this article: Bone Joint J 2020;102-B(6):677–682.

scholarly journals Antibiotics prescription in the elderly across different clinical areas; A real-life clinical audit

2021 ◽  
Vol 2 (4) ◽  
pp. 53-58
Author(s):  
Khaled Madi ◽  
Joyce Luk ◽  
Seline Sutton ◽  
Amr Elkammash ◽  
Sathyabama Loganathan
Keyword(s):  
Antibiotic Prescription ◽  
Compliance Rate ◽  
National Health System ◽  
Real Life ◽  
Working Hours ◽  
The Elderly ◽  
Out Of Hours ◽  
The Uk ◽  
Hospital Wards ◽  
Selection Of

Ageing of the population represents a great challenge to the national health system (NHS) in the UK. Patients in this age group have multiple comorbidities and use polypharmacy. They also have alterations in the absorption, metabolism and excretion of drugs. These factors make them susceptible to developing side effects and drug interactions on using antibiotics.Our team audited the safety of antibiotic prescription in elderly patients (above 85 years of age) in regards to the selection of the appropriate antibiotics, and the documentation of the indication and duration of them. We also compared the prescription process during working hours and out of hours. We recruited 20 patients from each of the three departments involved in their care: The Old people admission unit (OPAU), the geriatric wards and other hospital wards. Our minimum compliance rate was 95% in each of the studied parameters. We spotted a significant compromise in the antibiotic prescription on non-geriatric wards and out of hours. This goes with the concerns raised by other studies. We recommend continuous education and the setting up of campaigns to increase the awareness of the medical staff on this aspect.

scholarly journals Traumatic sacral dermoid cyst rupture with intracranial subarachnoid seeding of lipid particles: illustrative case

2021 ◽  
Vol 2 (24) ◽  
Keyword(s):  
Systematic Review ◽  
Dermoid Cyst ◽  
Cauda Equina ◽  
Illustrative Case ◽  
Fat Deposits ◽  
Mri Scans ◽  
Life Threatening ◽  
Magnetic Resonance Imaging Mri ◽  
Sacral Canal ◽  
Cyst Rupture

BACKGROUND Intracranial deposits of fat droplets are an unusual presentation of a spinal dermoid cyst after spontaneous rupture and are even more uncommon after trauma. Here, the authors present a case with this rare clinical presentation, along with a systematic review of the literature to guide decision making in these patients. OBSERVATIONS A 54-year-old woman with Lynch syndrome presented with severe headache and sacrococcygeal pain after a traumatic fall. Computed tomography of the head revealed multifocal intraventricular and intracisternal fat deposits, which were confirmed by magnetic resonance imaging (MRI) of the neuroaxis; in addition, a ruptured multiloculated cyst was identified within the sacral canal with proteinaceous/hemorrhagic debris, most consistent with a sacral dermoid cyst with rupture into the cerebrospinal fluid (CSF) space. An unruptured sacral cyst was later noted on numerous previous MRI scans. In our systematic review, we identified 20 similar cases, most of which favored surgical treatment. LESSONS Rupture of an intraspinal dermoid cyst must be considered when intracranial fat deposits are found in the context of cauda equina syndrome, meningism, or hydrocephalus. Complete tumor removal with close postoperative follow-up is recommended to decrease the risk of complications. CSF diversion must be prioritized if life-threatening hydrocephalus is present.

The morbidity of out-of-hours surgery for Cauda Equina Syndrome

2022 ◽  
pp. 1-4
Author(s):  
Aditaya Kumar ◽  
Phil Copley ◽  
Aimun Jamjoom ◽  
Khaled Badran ◽  
Christopher Barrett
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Out Of Hours

scholarly journals Supply and Demand in Liver Transplantation Surgery: Implications for Training in the UK

2013 ◽  
Vol 95 (8) ◽  
pp. 1-5
Author(s):  
SJ McNally ◽  
RW Parks ◽  
SJ Wigmore
Keyword(s):  
Liver Transplantation ◽  
Supply And Demand ◽  
Significant Proportion ◽  
Working Hours ◽  
Working Time ◽  
Out Of Hours ◽  
Medical Graduates ◽  
Transplantation Surgery ◽  
European Working ◽  
The Uk

At the end of the 1990s there was a perceived crisis in the recruitment of transplant surgeons in the UK. transplantation surgery is a demanding specialty, requiring a significant proportion of time to be spent in out-of-hours work performing prolonged and technically demanding surgery. Other factors, such as reduced working hours associated with the implementation of the european Working time regulations and the changing expectations of new medical graduates, are thought to have contributed to making training in liver transplantation surgery an unattractive option.

Lessons learnt from setting up a UK urgent dental care centre during the COVID-19 pandemic

2021 ◽  
Vol 12 (2) ◽  
pp. 64-71
Author(s):  
Abisola Asuni ◽  
Emily Carter ◽  
Jenna Trainor ◽  
Alex Daly ◽  
Kelly Gillan ◽  
...  
Keyword(s):  
Dental Care ◽  
Working Hours ◽  
Protective Equipment ◽  
Out Of Hours ◽  
Dental Hospital ◽  
Dental Practices ◽  
The Uk ◽  
Staff Wellbeing ◽  
Staffing Requirements ◽  
Dental Conditions

When the COVID-19 pandemic led to the closure of general dental practices throughout the UK on 23 March 2020, Newcastle Dental Hospital became a regional in-hours urgent dental care hub treating ‘hot’ (COVID-19 positive, self-isolating), ‘warm’ (shielding, vulnerable) and ‘cold’ (other) patients. It provided urgent dental care to over 3,000 patients in the first 6 weeks. With no other urgent dental care centres being operational until 15 April, the hospital was the sole care provider (both during normal working hours and out of hours) to a population of over 3 million for more than 3 weeks. Consideration of staffing requirements, logistics, staff wellbeing, personal protective equipment, referral pathways, clinic setup and management of urgent dental conditions during the COVID-19 pandemic are discussed along with the challenges faced.

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