Keywords:
Acute, Surgery, Outcomes analysis, MR, Neuroradiology spine, Musculoskeletal spine, Emergency
Authors:
H. M. A. OBrien, G. Karnati, J. Kasznia-Brown, S. King, P. Burn; Taunton/UK
DOI:
10.26044/ecr2019/C-1124
Conclusion
Since the introduction of updated clinical pathways pertaining to the management of cauda equina syndrome and malignant spinal cord compression the number of out of hour MRI scans has increased significantly in our trust.
Of patients with positive findings of cord or cauda compression on their MRI,
only 24% underwent same night surgery.
Deciding to operate overnight is complex and requires careful assessment of the benefits versus risks to the patient.
Some factors we identified that seemed to play a role in deciding whether or not to operate on patients with positive findings on MRI included patients not being suitable surgical candidates and patients with co-morbidities.
Resource implications in terms of staffing on-call spinal surgery rotas no doubt also play a role in deciding whether or not to operate OOH.
Nonetheless,
the increased number of OOH MRI scans being performed has placed significant strain on resources and staffing within our department.
The very low rate of subsequent same night surgery for those with positive scans may indicate the need for improved clinical triage pathways,
specifically,
identifying patients who are not surgical candidates from the outset.