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Cauda Equina Syndrome Audit: A DGH Perspective and Review
Poster Title: Cauda Equina Syndrome Audit: A DGH Perspective and Review
Submitted on 29 Oct 2020
Author(s): Sachin Bhardwaj (SHO), Joseph Ofran (Radiographer), Oran Roche (Consultant Radiologist), Dario Prudencio (MR Superintendent)
Affiliations: Luton and Dunstable Hospital
This poster was presented at BIR Annual Congress
Poster Views: 68
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Poster Information
Abstract: Cauda equine syndrome (CES) is a rare but potentially devastating orthopaedic emergency that can result in permanent neurological deficit including urinary or bowel incontinence and sexual dysfunction. While it has long been subject to high levels of medico-legal issues, the indications and urgency of magnetic resonance imaging (MRI) are often under scrutiny. This is epitomised within district general hospitals (DGHs) where there is no access to 24/7 MRI scanning. Although there are no national guidelines for CES, established standards of care have been set out by the British Association of Spine Surgeons which state that MRI must be undertaken as an emergency, take precedence over routine cases and be available 24/7 at the referring hospital. Indicators used for this audit include percentage of MRIs performed within 1, 4 and 24 hours of request, percentage positive for CES, percentage showing pathology but no CES and percentage unremarkable. The main target was 100% for MRI scanning within 24 hours. Data was collected between November 2019 – June 2020 and compared to results from previous years, exclusion criteria included outpatient requests and GP direct access requests. The main result was 95% of scans performed within 24 hours and 65% performed within 4 hours, with a 12% pick-up rate for CES; similar to figures quoted in literature. To improve the current care access to MRI 24/7 must be established, and the cost of this can perhaps be set against the cost of litigation, which stems from delays in management leading to irreversible damage.Summary: A local audit of Cauda Equina Syndrome from the perspective of a DGH. References: Standards of Care for Investigation and Management of Cauda Equina Syndrome – British Association of Spine Surgeons

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