Document Detail


The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess.
MedLine Citation:
PMID:  15028325     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Previous reports have recommended the use of a "classic triad" of fever, spine pain, and neurologic deficits to diagnose spinal epidural abscess (SEA); however, the prognosis for complete recovery is poor once these deficits are present. This retrospective case-control study investigates the impact of diagnostic delays on outcome and explores the use of risk factor screening for early identification of SEA in a population of ED patients. Inpatients with a discharge diagnosis of SEA and a related ED visit before the admission were identified over a 10-year time period. In addition, a pool of ED patients presenting with a chief complaint of spine pain was generated; controls were hand-matched 2:1 to each SEA patient based on age and gender. Data regarding demographics, presence of risk factors, physical examination findings, laboratory and radiographic results, and clinical outcome were abstracted from medical records and entered into a database for further analysis. Patients with SEA were compared to matched controls with regard to the prevalence of risk factors and the "classic triad." We also explored the impact on outcome of diagnostic delays, defined as either: 1) multiple ED visits before diagnosis, or 2) admission without a diagnosis of SEA and >24 h to a definitive study. A total of 63 SEA patients were hand-matched to 126 controls with spine pain. Diagnostic delays were present in 75% of SEA patients. Residual motor weakness was present in 45% of these patients vs. only 13% of patients without diagnostic delays (odds ratio 5.65, 95% C.I. 1.15-27.71, p < 0.05). The "classic triad" of spine pain, fever, and neurologic abnormalities was present in 13% of SEA patients and 1% of controls during the initial visit (p < 0.01); one or more risk factors were present in 98% of SEA patients and 21% of controls (p < 0.01). The erythrocyte sedimentation rate (ESR) was more sensitive and specific than total white blood cell (WBC) count as a screen for SEA. In conclusion, diagnostic delays are common in patients with SEA, often leading to irreversible neurologic deficits. The use of risk factor assessment is more sensitive than the use of the classic diagnostic triad to screen ED patients with spine pain for SEA. The ESR may be a useful screening test before magnetic resonance imaging in selected patients.
Authors:
Daniel P Davis; Ruth M Wold; Raj J Patel; Ailinh J Tran; Rizwan N Tokhi; Theodore C Chan; Gary M Vilke
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of emergency medicine     Volume:  26     ISSN:  0736-4679     ISO Abbreviation:  J Emerg Med     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-18     Completed Date:  2004-08-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8412174     Medline TA:  J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  285-91     Citation Subset:  IM    
Affiliation:
Department of Emergency Medicine, University of California, San Diego, San Diego, California 92103-8676, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Distribution
Back Pain / epidemiology
California / epidemiology
Case-Control Studies
Emergency Medicine / methods*
Emergency Service, Hospital / statistics & numerical data*
Epidural Abscess / diagnosis*,  epidemiology*
Female
Fever / epidemiology
Humans
Likelihood Functions
Male
Mass Screening / methods,  statistics & numerical data
Middle Aged
Nervous System Diseases / epidemiology
Prevalence
Retrospective Studies
Risk Assessment / methods,  statistics & numerical data
Risk Factors
Sensitivity and Specificity
Sex Distribution

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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