Submitted on 27-09-2014
P Heire, N Winn
British Institute of Radiology
Cauda equina syndrome (CES) occurs by compression of the thecal sac below the level of the spinal cord and is considered a surgical emergency, although it has been suggested that intervention should be performed within 24 hours. Imaging plays a major role in the diagnosis and management of CES but can potentially add delays. In this audit we aimed to assess the timing of MRI scanning and reporting at our large Teaching Hospital for patients with suspected CES.
45 patients were referred for an MRI scan of the spine for suspected CES over a period of 3 months. Clinical indications included low back pain (84.4%), lower limb neurology (73.3%), sphincter disturbance (35.6%) and saddle anaesthesia (9%). Overall, 67% of patients were scanned and had a report issued within 24 hours. There were 5 positive cases for CES (11%), 24 patients had abnormalities other than cauda equina compression (53%) and 16 patients had normal scans (36%). 1 patient who had cauda equina compression on MRI had waited over 24 hours for a formal report.
Conclusion & Discussion:
At present, there is delay in providing patients with an MRI spine for suspected CES within 24 hours, with one cauda equina patient breaching this target. The service could be improved by streamlining MRI services during working hours and by providing out-of-hours access. Collaboration with the Emergency Department and development of local guidelines would also play a major role in improving our MRI service for these patients.
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