The Cauda Equina Syndrome Early Recognition (CESER) Study: a mixed-methods study to improve diagnosis of cauda equina syndrome in the Emergency Department

Research summary

Cauda equina syndrome (CES) describes symptoms caused by a disc from the spine pushing on the nerves at the end of the spinal cord. These nerves supply the legs, bladder, anus and sexual organs, and can become damaged if compressed for too long. Most patients with CES require an emergency operation to take pressure off the nerves. First, we will recruit 2000 patients admitted with suspected CES across a number of NHS hospitals. These patients will be examined carefully by a doctor before anyone knows the result of their MRI scan. We will then take the results of the MRI scan and look back to see whether any signs or symptoms were particularly helpful in working out which patients would end up with a final diagnosis of CES. We will contact patients with confirmed CES after 6 weeks, 6 and 12 months to ask about their symptoms and quality of life. A smaller group of patients will be interviewed, as part of an embedded qualitative study, to learn more about their experiences of being assessed for CES. Second, we will ask all NHS hospitals with EDs how they manage patients who might have CES. This will help us determine where there are obvious problems or delays and major differences between hospitals. It will also help us identify hospitals that have found useful ways to diagnose CES quickly. We will use this information, together with the data from the study of 2000 patients, to estimate the cost consequences of different methods of managing patients with suspected CES. These studies have been designed to help all hospitals provide high-quality care across the NHS for patients that might have CES. This should make healthcare more efficient (and so possibly cheaper) at the same time as reducing harm to patients. Although lots of people attend Emergency Departments with back pain, very few have CES. Unfortunately, CES can be difficult to diagnose and an MRI scan is currently required to make a definitive diagnosis. This is a problem as MRI scanning is not available in all hospitals at night and we know that some patients end up waiting too long before getting a diagnosis. It is not known whether any particular pattern of symptoms can help us rule out the diagnosis without a MRI scan. This study will try to determine whether any pattern of symptoms can help us identify which patients are very unlikely to have CES. It will also help determine what pathway for patients should be followed when they arrive at an ED with symptoms that could be caused by CES.

Principal Investigator

Dr Jonny Glover

Contact us

Email: emergency.research@oxnet.nhs.uk

IRAS number

356791