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

Higginson, Robin and Letheren, Andrew and Selfe, James and Greenhalgh, Sue and Mercer, Chris (2020) A service evaluation of patients suspected of Cauda Equina Syndrome referred to accident and emergency departments from a national telephone triage service. Musculoskeletal Science and Practice, 50. p. 102248. ISSN 2468-7812

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Abstract

Background The presentation and management of Cauda Equina Syndrome (CES) remains contentious in medical literature, however it is widely agreed that CES requires emergency medical attention. Physiotherapists will often refer suspected cases to A&E departments for emergency medical review in order to safeguard patient safety. Objectives To evaluate the management of patients triaged by a national telephone service referred to A&E for suspected CES. Method Known escalations (17 cases) from January 2017 to June 2017 from a national telephone triage service referred to A&E with suspected CES were included. Results 53% of cases with CES symptoms that conformed to the BASS definition of having a requirement for diagnostic imaging were not investigated by MRI scan. The MRI and non-MRI groups had similar group sizes (8 : 9) and mean ages (42.4 years ± 8SD and 45.7 years ± 12SD). Overall, there were more females (11) compared to males (6) referred to A&E. Conclusion There appears to be significant variability in the management of this cohort of patients once referred to emergency departments. Further guidance is needed as to when watchful waiting is clinically appropriate, and what best practice should be to facilitate safe patient management.

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