Title : Cauda equina syndrome- can we get it right first time? An audit of orthopaedic and emergency departments in St Marys Hospital, Isle of Wight
Abstract:
The cauda equina is a collection of nerves and nerve roots distal to the terminal end of the spinal cord, the conus medullaris, typically stemming from L1 to L5. Cauda Equina Syndrome (CES) often occurs due to compression of these nerve roots. It is rare but potentially devastating, and can cause severe symptoms, such as bilateral sensory and motor deficits, and urinary, bowel and sexual dysfunction. A detailed history is essential to identify red flag symptoms in patients suspected of having cauda equina syndrome, and should include back pain, bowel or bladder changes and bilateral sciatica. Decreased anal tone, saddle anaesthesia, and bilateral weakness and sensory deficit to the lower limbs. The Getting It Right First Time (GIRFT) team created a national CES pathway (February 23) to support teams making diagnosis and treating the condition without delay as per best practice guidelines for referral, imaging, surgical techniques, pain control and post-operative support. We are presenting an audit of 40 patients presenting to St Marys Isle of Wight Hospital orthopaedic and emergency departments, and whether their history, examination and documentation adhered to the GIRFT pathway. Of 40 patients audited identified from the orthopaedic take list- 13 had no available data. 18 patients were asked about sudden onset bilateral radicular pain or unilateral radicular leg pain that has progressed to bilateral. 22 patients were asked about severe lower back pain. 15 patients were asked about altered perianal, perineal or genital sensation S2-S5 dermatomes. 24 patients were asked about difficulty initiating micturition or impaired sensation of urinary flow (urinary incontinence). 12 patients were asked regarding severe or progressive neurological deficit of both legs, such as major motor weakness with knee extension, ankle eversion, or foot dorsiflexion. No patients asked about sexual dysfunction. Only 5 out of 25 patients had documentation of post-void bladder scan, and only 1 patient had a documented catheter tug. Only 17/25 patients had sensory examinations documented, with minimal dermatomal distribution. We conclude that the documentation of patients referred with CES is poor. Key areas identified for improvement are the sensory examination and bladder scan. We have designed a proforma to aid documentation of history taking and examination. We plan to reaudit this once the proforma enters circulation at St Marys Hospital, Isle of Wight.
What will audience learn from your presentation?
- The importance of diagnosing Cauda Equina with detailed history and well documented examination findings
- The Getting it Right First Time Pathway
- Improve the accuracy of history taking in patients with query Cauda Equina in emergency settings
- More research is needed to further aid the diagnosis of Cauda Equina
