Keywords:
Emergency, Musculoskeletal spine, CT, Audit and standards, Decision analysis, Acute, Patterns of Care, Trauma
Authors:
D. Luong, C. Maiskell
DOI:
10.26044/ranzcr2022/R-0220
Methods and materials
This single-centre retrospective audit included all anonymised patients that underwent a CT lumbar spine from April 2021 to July 2021 in ED at SCUH. Data was extracted via the electronic medical record including the reason for referral and subsequent radiological findings. Results were analysed and the reason for referral was stratified according to the RANZCR choosing wisely Guideline's simplified classification of (1) lower back pain in the setting of radiculopathy (leg pain in L4, L5 and/or S1 nerve root distribution, positive straight leg raise or crossed straight leg raise test) or spinal canal stenosis (radiating leg pain, neurogenic pseudoclaudication, sensory loss ± weakness in the legs bilaterally (68%) involving the entire leg (78%), (2) serious spinal pathology including history of cancer/metastatic disease, infections including epidural abscess, discitis, osteomyelitis (fever, history of intravenous drug use, recent invasive procedure, elevated CRP ± white blood cell count, fracture (significant trauma, >70 years of age, corticosteroid use, female gender), cauda equina syndrome (new urinary retention, faecal incontinence, saddle anaesthesia), or severe neurological deficit (progressive motor weakness, motor deficits at multiple neurological levels, and; (3) non-specific low back pain (absence of lower back pain in the setting of serious spinal pathology, radiculopathy or spinal canal stenosis)3. Stratified results were then correlated with radiological findings and analysed. Descriptive statistics were then used to report and summarise the results in text and graphical form.