A service evaluation of patients suspected of Cauda Equina Syndrome referred to accident and emergency departments from a national telephone triage service

Abstract

The British Association of Spine Surgeons (BASS) (Germon et al., 2015) produced guidelines relating to the management of patients with suspected Cauda Equina Syndrome (CES). These are detailed as "A patient presenting with acute (de novo or as an exacerbation of pre-existing symptoms) back pain and/or leg pain with a suggestion of a disturbance of their bladder or bowel function and/or saddle sensory disturbance should be suspected of having a CES. Most of these patients will not have critical compression of the cauda equina. However, in the absence of reliably predictive symptoms and signs, there should be a low threshold for investigation with an emergency scan." This clinical study reviews the management of patients triaged by a national telephone service subsequently referred to A&E for suspected CES relative to BASS guidance.

Review on Diagnosis and Management of Cauda Equina

“…In the emergency room, the ultrasonography measurement of post-voiding residual bladder capacity is frequently utilized to detect CES. Again, despite its widespread use, there is not enough evidence to prove its validity in CES assessment, as writers have stated that a variety of residual volumes (100/200/500ml) may be necessary to determine any degree of bladder retention [17].…”

Cauda Equina Syndrome Clinical Guidelines Review

“…Presentation is acute or sudden onset with progressive worsening where urgent emergency referral to secondary care services for exclusion and or intervention is required 1 . Significant variability exists among clinicians in management from referral to secondary care and attention received in accident and emergency department (ED) 12 . However, early diagnosis is a key factor in reducing the financial burden on NHS services which is a key agenda of current common pathways development 13 .…”

“…Under the current pandemic face to face consultations are replaced with telephone triages, and lack of MSK-trained clinicians, difficulty with hospital admission, and burden of care seem to be among the barriers to early diagnosis 12 . NICE guideline of chronic pain in over 16 assessment and management August (2020) has completely overlooked ever debatable CES.…”