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a lower back pain imageMay 9 2018

The Medical Protection Society is advising doctors of a revision to the NICE Clinical Knowledge Summaries (CKS) red flag symptoms for cauda equina syndrome.

MPS said the cauda equina red flags “are now more explicit, enable earlier referral, and could have a significant impact on patient safety.”

It has been working with NICE to update the information as it found that “failure or delay in diagnosis of cauda equina syndrome was one of the top five errors that led to the most expensive GP claims. 

“Over the last 5 years (2013-2017) MPS has received 105 claims – mostly arising from primary care – involving cauda equina syndrome. Such cases typically settle for six figure sums where negligence is established, although in some cases where the resulting issues have led to long-term care being required, the costs can run into millions,” said MSP.

The red flags are:

  • bilateral sciatica;
  • severe or progressive bilateral neurological deficit of the legs, such as major motor weakness with knee extension, ankle eversion, or foot dorsiflexion;
  • difficulty initiating micturition or impaired sensation of urinary flow, if untreated this may lead to irreversible urinary retention with overflow urinary incontinence;
  • loss of sensation of rectal fullness – if untreated this may lead to irreversible faecal incontinence;
  • perianal, perineal or genital sensory loss (saddle anaesthesia or paraesthesia);
  • laxity of the anal sphincter.

The causa equina red flags appear in the CKS for Sciatica (lumbar radiculopathy) as signs and symptoms may overlap.

Links:
MPS announcement     
NICE CKS Sciatica (lumbar radiculopathy) red flag symptoms and signs    

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