Title : Local implementation of GIRFT guidance can reduced Cauda Equina Syndrome (CES) related service pressures without negatively impacting diagnosis - Retrospective observational study at a District General Hospital
Abstract:
Background: Cauda Equina Syndrome (CES) is a rare but serious neurosurgical emergency requiring substantial resources to ensure its safe exclusion. Get It Right First Time (GIRFT) published recommendations in February 2023 to guide clinicians assessing potential cases with respects to the decision to undertake scanning. Within our local hospital this framework has been adopted by the on-call orthopaedic service to help manage the high volume of referrals it receives. The aim of this audit is to assess whether implementing GIRFT guidance eased CES related service pressures without reducing our sensitivity for diagnosing this emergency.
Methods: Retrospective review of all patients undergoing MRI scanning to exclude CES during two 6-month periods. GIRFT guidance was published in February 2023. The first period (01/08/2022-31/01/2023) was pre-GIRFT guidance and the second period (01/08/2024-31/01/2025) was more than one year after GIRFT publication. Exclusion criteria were any self-discharges before scanning, outpatient scanning or scanning for trauma/infection. Data was extracted using predesigned proformas. Statistical analysis was undertaken using Chi-squared and two sample T testing.
Results: There were 175 inpatients MRI scans to exclude CES during the first period versus 159 during the second. In the second 6 months, there was a significant reduction in percentage of patients requiring admission (42.77% versus 56.57%, p = 0.011) and an increase in the percentage of patients scanned on the day of presentation, although the study was inadequately powered to show significance (61.64% versus 52%, p = 0.076). There was no change in the sensitivity of inpatient scans for identifying CES (4.57% versus 4.4%, p = 0.941).
Conclusion: Our results show that adoption of the GIRFT pathway within our hospital reduced pressure on our services without negatively impacting detection of CES. These findings could be used to drive similar practices in other district general hospitals.
