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

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 safeg...

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Bibliographic Details
Published in:	Musculoskeletal science & practice Vol. 50; p. 102248
Main Authors:	Higginson, Robin, Letheren, Andrew, Selfe, James, Greenhalgh, Sue, Mercer, Chris
Format:	Journal Article
Language:	English
Published:	Elsevier Ltd 01-12-2020
Subjects:	Cauda equina syndrome Physiotherapy Physiotherapy escalation management Telephone Triage Triage Telephone Cauda equina syndrome Physiotherapy escalation management Physiotherapy
Online Access:	Get full text
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Summary:	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. To evaluate the management of patients triaged by a national telephone service referred to A&E for suspected CES. 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. 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. 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. •Presentation and management of Cauda Equina Syndrome (CES) remains contentious.•Widely agreed that CES requires urgent medical attention.•Physiotherapists will often refer for urgent medical review.•Appears to be significant variability in the management CES once referred to A&E.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2468-7812 2468-7812
DOI:	10.1016/j.msksp.2020.102248