Title : Utilisation and diagnostic performance of the SuCESS cauda equina triage tool in a UK District General Hospital (DGHs)
Abstract:
Aims: To evaluate the diagnostic performance of the Suspected Cauda Equina Syndrome Score (SuCESS) in a UK District General Hospital (DGH) emergency department.
Methods: This retrospective single-centre diagnostic accuracy study included adults presenting with suspected Cauda Equina Syndrome (CES) to a DGH emergency department between 1 January 2023 and 31 December 2025. Eligible patients were identified from emergency department coding and urgent MRI requests. Scores were reconstructed retrospectively. Decompression confirmed CES was the reference standard. The primary analysis included only patients with complete SuCESS data, with prespecified sensitivity analyses incorporating partially documented but scorable cases. Diagnostic performance at the published threshold of ≥ 3 points was summarised using test characteristics, and discrimination was assessed with the area under the receiver operating characteristic curve (AUC).
Results: Among 453 patients with suspected CES, 29 underwent urgent decompression. The complete-case cohort comprised 383 patients (26 CES, 357 non-CES). At a SuCESS threshold ≥ 3, sensitivity was 80.8%, specificity 67.2%, positive predictive value 15.2%, negative predictive value 98.0%, positive likelihood ratio 2.46, negative likelihood ratio 0.29, and accuracy 68.1%. The AUC was 0.78 (95% confidence interval, CI, 0.70–0.85) in the complete case cohort, and 0.76 (95% CI 0.68–0.83) in the full scorable cohort (n = 452).
Conclusion: In this DGH cohort, SuCESS showed fair discrimination and high negative predictive value but substantially lower sensitivity than originally reported, missing five decompression confirmed CES cases at the published threshold. SuCESS appears useful as a structured assessment and triage aid but should not be used in isolation to exclude CES or to defer MRI.
Clinical Relevance: Provides early external validation of SuCESS in a non tertiary emergency department setting. Supports using SuCESS to standardise documentation and triage, while cautioning against its use as a stand-alone rule-out test for CES.
