Cauda Equina Syndrome in the Emergency Department: A 2-year Single Centre Retrospective Review.

Cauda equina syndrome (CES) is a rare but serious condition that affects the bundle of nerves at the bottom of the spinal cord. Pressure on these nerves can lead to permanent loss of bladder and bowel control, as well as sensation and movement in the legs. Recognising CES early is crucial to prevent these devastating complications.

Victor Ameh, Consultant in A&E Medicine, alongside two of his peers, Ibrahim Shodipe and Lakshmi Adhikari, summarises a two-year study conducted to understand how often CES is suspected in the emergency department (ED), how it’s diagnosed, and how patients are treated.

CES: A Rare but Concerning Condition

The study highlights the relative rarity of CES, with a prevalence of only 0.07% of all ED visits. However, even with a low incidence, the potential consequences are severe. Early diagnosis is key to preventing permanent disability.

Identifying Potential CES Cases

The study used criteria established by the National Institute for Health and Care Excellence (NICE) to identify potential CES cases. These criteria, known as “red flag symptoms,” include:

  • Bladder dysfunction
  • Bowel dysfunction
  • Difficulty walking or gait disturbance
  • Loss of sensation around the anus or genitals

Key Findings of the Study

  • A total of 148 patients presented with suspected CES over the two-year period.
  • Women were more likely to be diagnosed than men (70% vs 30%).
  • Two age groups were most commonly affected: adults aged 24-65 and those over 75.
  • Most patients (92%) received conservative management, likely while awaiting further evaluation or surgery.
  • Nearly two-thirds of patients (68%) were admitted to the hospital for further investigation or treatment.
  • Importantly, 95% of patients met the NICE red flag criteria, indicating a high degree of accuracy in identifying potential CES cases.

The Importance of Early Recognition

This study highlights the importance of recognising CES symptoms in the ED. While the condition is rare, its potential consequences are severe. By being aware of the red flag symptoms and using appropriate diagnostic tools, healthcare professionals can ensure prompt intervention and improve patient outcomes.

About Mr Victor Ameh

Mr Victor Ameh, Consultant in Accident and Emergency Medicine and Expert Witness

24 June 2024

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