Cauda Equina Syndrome: A Survey of Guideline Utilisation in Primary Care in England

Gill, J ORCID: https://orcid.org/0000-0003-4234-1033, Greenhalgh, Susan ORCID: https://orcid.org/0000-0002-2259-0123, Latour, JM ORCID: https://orcid.org/0000-0002-8087-6461 and Yeowell, G ORCID: https://orcid.org/0000-0003-3872-9799 (2025) Cauda Equina Syndrome: A Survey of Guideline Utilisation in Primary Care in England. Musculoskeletal Care, 23 (2). e70129. ISSN 1478-2189

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Abstract

Background: Cauda equina syndrome (CES) is a spinal emergency. Over half of known cases first present to primary care for initial assessment. In February 2023, the Getting It Right First Time (GIRFT) national programme launched new CES guidelines, which included an important change in practice: a new urgent referral route. Aim: This study aims to explore the awareness and use of the GIRFT guidelines in a primary care setting in England. Design and Setting: A cross-sectional online survey was used to collect data from primary care clinicians working across England. Method: Using purposive sampling, the survey was shared with primary care clinicians across England and conducted between 21-10-2024 and 24-12-2024. The RE-AIM framework underpinned the survey design. Descriptive analysis was employed to interpret frequency and Likert data. Results: A total of 515 responses were received from across all 42 integrated care boards in England. Of the 515 participants, 452 (88%) were aware of a CES guideline or pathway, with 297/515 (58%) being aware of the GIRFT guidelines. Two-thirds had access to a local CES pathway (n = 304/452, 67%). Nearly all clinicians highlighted that consulting either a local CES pathway or national guidelines supported their clinical decision making. Conclusion: This is the first study to investigate the awareness and utilisation of the GIRFT guidelines in primary care across England. The use of locally agreed CES pathways was shown to increase adherence to their recommendations in primary care. These findings suggest that using up-to-date local CES pathways can increase adherence to the GIRFT guidelines.