A report from the NHS Healthcare Safety Investigation Branch (HSIB) has highlighted the risks of delaying MRI scans for suspected cauda equina syndrome (CES).
This rare but life-changing condition is caused by compression of nerves at the end of the spinal cord within the spinal canal.
The HSIB investigation was based on the case of a 32-year old woman with a delayed diagnosis of CES, who had been suffering pelvic, back, and lower abdominal pain and had seen her GP six times over two months.
Four days after a visit to A&E she had an MRI and was urgently transferred to a specialist centre for confirmation and treatment. She arrived in the early hours of the morning and her surgery took place later that same day. It confirmed she had ‘75% blockage of the spinal canal’. The patient received intensive rehabilitation but still has ongoing back pain and neurological problems.
The investigation explored the issues at a national level, looking at the diagnostic challenges relating to CES, access and timing of MRI scans, how the diagnosis of CES is supported, national diagnostic pathways and role of spinal networks in England, and ‘safety netting’ advice and communication - both with patients and between hospitals and specialist centres.
The HSIB investigation found:
- Variation in the timeframes in which patients with suspected CES receive an MRI scan.
- Many local hospitals cannot use their MRI scanners out of hours, for a number of reasons.
- There is no NICE guidance specifically on CES.
- Variations exist in treatment pathways across the system and within specific spinal networks.
- Safety-netting leaflets on the symptoms associated with CES were inconsistent in their level of detail and language.
The report recommends a list of changes aimed at reducing the delay in diagnosis via MRI scans, developing consistent national pathways/guidance and improving communication to patients.
One safety recommendation called for guidance to be developed by The Royal College of Radiologists (RCR), supported by the Society and College of Radiographers, stating that all hospitals should reserve the first MRI slot of the day for patients with suspected cauda equina syndrome who do not meet the criteria for an ‘emergency’/immediate scan overnight.
The HSIB also suggested: ‘It may be beneficial for hospital trusts without 24 hours a day, seven days a week MRI provision, and the potential to see patients with suspected cauda equina syndrome, to consider expanding the skills of their radiographers to allow out-of-hours MRIs if required’.
SoR professional officer for senior service managers and cross sectional imaging lead Alexandra Lipton said: ‘SoR welcomes this report which acknowledges the challenges faced by imaging services in providing timely access for patients with suspected CES. We support protected time and increased availability of MRI slots to accommodate these patients.
'We have been working with the RCR and IPEM on producing further guidance for services. This will be published soon by the Clinical Imaging Board.'
Kathryn Whitehill, principal national investigator at HSIB said: 'Ensuring that there is no delay in accessing the right clinical tools, if CES is suspected, will greatly reduce the risk of long-term complications for patients'.
Read the full report: Timely detection and treatment of cauda equina syndrome