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

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.

590 False Positives Bladder Scan in Anuric Patient with Ascites: A Case Report

Introduction Urinary retention is one of the common presentations. Sometimes the clinical examination is unreliable, especially in patients with high BMI, ascites or anasarca. This makes the diagnosis uncertain and the bladder scan readings should be interpreted with caution. Thus, radiological imaging might be required before planning further intervention. Case presentation An 83-year-old woman was admitted under the medical team for sepsis secondary to soft tissue infection. She had multiple comorbidities and morbid obesity with a BMI of 58. Lab results showed an AKI. Initial Bladder scan showed 900 cc. Five uneventful attempts of urinary catheter insertion by the medical team, but still, no urine output and the bladder scan showing positive readings. Supra public catheter was considered. On review, the urinary catheter was in place, no evidence of blood per urethra and the bladder scan showed a reading of around 900 cc. Based on patient’s significantly high BMI, background history, uneventful catheterization and persistent reading on bladder scan. False reading on bladder scan was suspected. Out of hours CTKUB showed significant amount of ascites. Discussion: Bladder scan is sensitive for detecting any fluid in the abdomen not specifically urine in the bladder.Formal imaging should always be considered to confirm diagnosis.

Screening for aneurysms of the abdominal aorta using a simple screening device

Introduction Several countries advocate screening for aneurysms of the abdominal aorta (AAA) in selected patients. In the Netherlands, routine screening is currently under review by the National Health Council. In any screening programme, cost-efficiency and accuracy are key. In this study, we evaluate the Aorta Scan (Verathon, Amsterdam, Netherlands), a cost-effective and easy-to-use screening device based on bladder scan technology, which enables untrained personnel to screen for AAA. Methods We subjected 117 patients to an Aorta Scan and compared the results to the gold standard (abdominal ultrasound). We used statistical analysis to determine sensitivity and specificity of the Aorta Scan, as well as the positive and negative predictive values, accuracy, and inter-test agreement (Kappa). Results Sensitivity and specificity were 0.86 and 0.98, respectively. Positive predictive value was 0.98 and negative predictive value was 0.88. Accuracy was determined at 0.92 and the Kappa value was 0.85. When waist–hip circumferences (WHC) of > 115 cm were excluded, sensitivity raised to 0.96, specificity stayed 0.98, positive and negative predictive value were 0.98 and 0.96, respectively, accuracy to 0.97, and Kappa to 0.94. Conclusion Herein, we show that the Aorta Scan is a cost-effective and very accurate screening tool, especially in patients with WHC below 115 cm, which makes it a suitable candidate for implementation into clinical practice, specifically in the setting of screening selected populations for the presence of AAA.

To What Extend does Reported Practice from Nurses in Management of Indwelling Urinary Catheters Reflect National Evidence-based Guidelines?

In recent years, Catheter-Associated Urinary Tract Infection (CAUTI) has progressively developed into a major hospital complication accounting for 60% of hospital-acquired infections; it is costly and morbid. Nurses account for more than half of the catheterisation conducted within hospitals. Due to this reason, it was important to identify whether nursing practice on the management of indwelling urinary catheter was in the reflection of the current national guidelines. The survey is conducted on 32 participants who reveal the strengths and limitation within the areas. Nurses account for more than half of the catheterisation conducted within the hospital. In order to prevent CAUTI complication, the research suggested training and education as the main solution since nurses significantly exhibited poor performance in terms of knowledge and skills in the area of catheterisation, especially in the induction process. Moreover, the study reveals that the use of bladder scan and system intervention which has been identified to reduce the number of catheter insertions contributes to the reduction of urinary bacterial infection.