New Cauda Equina Syndrome Recommendations Follow Safety Investigation

Priscilla Lynch 

August 24, 2021

The Healthcare Safety Investigation Branch (HSIB) has published a national investigation report and recommendations regarding the timely detection and treatment of non-malignant spinal cord compression (cauda equina syndrome, CES).

The investigation was launched after HSIB identified an event where a patient had several GP and hospital presentations before CES was diagnosed. Once a magnetic resonance imaging (MRI) scan identified the cord compression, there were further barriers to receiving timely emergency surgery to alleviate the compression.

As part of its investigation, HSIB made a number of safety recommendations:

  • HSIB recommends that the British Association of Spine Surgeons, supported by the Royal College of Surgeons of England and the Royal College of Emergency Medicine, develops a decision-making tool to support the identification of patients who need an immediate MRI for suspected CES (which may result in the patient being transferred for an MRI if this is not immediately available at the assessing site).

  • HSIB recommends that guidance is developed by the Royal College of Radiologists, supported by the Society and College of Radiographers, stating that all hospitals should reserve the first MRI slot of the day for patients with suspected CES who do not meet the criteria for an ‘emergency’/immediate scan overnight.

  • HSIB recommends that the British Association of Spine Surgeons oversees the development of national guidance to identify how ‘urgent’ and ‘emergency’ requests for scans for suspected CES are defined and prioritised.

  • HSIB recommends that the National Institute for Health and Care Excellence (NICE) should update its current low back pain guideline to include the symptoms and initial management of CES. This update should include a review of the role of supplementary investigations, such as bladder scanning, in patients with suspected CES.

  • HSIB recommends that NHS England and NHS Improvement develop a national CES pathway. This should define the safety-critical elements of the pathway and highlight areas that can be adapted locally.

This article originally appeared on Univadis, part of the Medscape Professional Network.


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