Development of a toolkit for early identification of cauda equina syndrome

Greenhalgh, Susan; Truman, Carole; Webster, Valerie; Selfe, James

doi:10.1017/s1463423616000062

Cited by 13 publications

(6 citation statements)

References 21 publications

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“… A team working culture should be fostered at all levels with clearly defined scopes of practice and mutual support between colleagues. Communication aids could include CES questioning prompts. The questioning pro forma advocated by participants was based on the CES cue card for clinicians developed by Greenhalgh et al (2016). The CES information leaflet included wording from the CES credit card which is currently available in over 30 languages from https://www.macpweb.org/Cauda-Equina-Information-cards.…”

Section: Discussionmentioning

confidence: 99%

“…Their experience levels are shown in Table 1. The trust had recently run training on CES and an established CES pathway was in place which included implementation of a CES toolkit (Greenhalgh, Selfe, Truman, & Webster, 2016). Participants were eligible if they had at least 6 months' experience in musculoskeletal physiotherapy and had managed at least three persons with suspected CES.…”

Section: Methodsmentioning

confidence: 99%

“…All participants raised the topic of a CES pathway, including their trust's questioning pro forma and a CES information leaflet which included safety netting information based on wording in the CES credit card developed by Greenhalgh et al (2016). These three elements were described as useful tools in facilitating communication and consistent management.…”

Section: Methodsmentioning

confidence: 99%

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Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges

Paling¹,

Hebron

2020

Musculoskeletal Care

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Introduction Cauda equina syndrome (CES) is rare, but its symptoms are not and musculoskeletal physiotherapists frequently encounter persons with suspected CES. Given that delayed diagnosis of CES can result in devastating consequences for affected persons and costly litigation for healthcare organisations, it is imperative that persons presenting with suspected CES are well managed. However, this may present a challenge to physiotherapists. Therefore, the aim of this study is to explore physiotherapists' experiences of managing persons with suspected CES. Methods Semi‐structured interviews were conducted with musculoskeletal physiotherapists. Verbatim transcripts were analysed using an interpretive paradigm and thematic analysis. Ethical approval Ethical approval was obtained from a university Ethics committee and NHS Research and Development. Findings Five interlinking themes emerged. The themes of worry in relation to risk management and communication difficulties seemed to represent significant challenges. The remaining themes were described as antidotes to these challenges: Lightening the load with teamwork and shared responsibility, the usefulness of a clear pathway and perception of improved confidence and competence with experience and training. Discussion The findings are discussed in the context of other literature, and practical recommendations are made relating to pathway implementation, team working, communication aids, training on CES and measures to care for staff wellbeing. Conclusion Findings suggest that it is important to be aware of and address the challenges faced by physiotherapists in order to care for clinicians' wellbeing and ensure a safe and smooth journey for persons with suspected CES. Summary Video: https://www.youtube.com/watch?v=lIHqCKIQ1jk&t=90s

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges

Paling¹,

Hebron

2020

Musculoskeletal Care

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“…Three of these clinical leads worked together to provide consistency with symptom analysis by reviewing the clinical case records and telephone assessment recordings of suspected CES cases for the purpose of this study. Symptoms of CES were noted and logged according to the CES warning signs detailed on the 'credit card' published by Greenhalgh et al (2015).…”

Section: Methodsmentioning

confidence: 99%

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

Higginson

Letheren

Selfe

et al. 2020

Musculoskeletal Science and Practice

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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.

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“…They consider safety netting goes wrong in three ways; correct information is not given in high risk situations, the language used is not heard or understood and the content of information is unclear. A qualitative study on Cauda Equina Syndrome (CES) patients found that patients had an inability to concentrate when consumed by very severe acute pain and their ability to express subtle symptom progression was also negatively affected (Greenhalgh et al, 2016). As a consequence, CES credit cards were developed for patients at risk of CES, by CES sufferers and are a good example of safety netting advice (Greenhalgh et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Safety netting; best practice in the face of uncertainty

Greenhalgh

Finucane

Mercer³

et al. 2020

Musculoskeletal Science and Practice

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Safety netting is a recognised General Practitioner (GP) diagnostic strategy often used in the face of uncertainty to help ensure that a patient with unresolved or worsening symptoms knows when and how to access further advice. It is an important way of reducing clinical risk. In the context of the COVID-19 pandemic and the rapid move to mainly remote consultations within the musculoskeletal field, safety netting is an important strategy to embed within all consultations. Only those presenting with potentially serious conditions are offered face to face consultations. Screening for Red Flags and any indication of a serious cause of symptoms is always first line in any consultation, however, clinical presentations are not always black and white with patients falling into a clear diagnostic category. With patients minds more focussed on COVID-19 symptoms this can be problematic. With the additional ramifications of public health social restrictions, onward management can be a conundrum. Many people with risk factors of serious pathology are also as a consequence, vulnerable to contracting COVID-19. In situations of uncertain clinical presentations, to avoid unnecessary social contact, safety netting can help to monitor symptoms over time until the clinical context becomes more certain. Embedding safety netting within physiotherapy best practice could be a silver lining in this pandemic black cloud.

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Development of a toolkit for early identification of cauda equina syndrome

Cited by 13 publications

References 21 publications

Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges

Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges

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

Safety netting; best practice in the face of uncertainty

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