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Hospital Repeatedly Fails To Diagnose Cauda Equina Syndrome

If your cauda equina syndrome was not diagnosed in a timely fashion, despite repeated hospital attendances, you may be have been subject to a substandard level of care.

First attendance

If a patient presents to A&E for the first time with severe back pain, sciatica and altered sensation in the lumbar region, the Emergency Department doctor should recognise these clinical features as being characteristic of cauda equina syndrome. Arrangements should therefore be made for a patient to be reviewed by the Orthopaedic team.

The Orthopaedic team should subsequently undertake a thorough assessment, including a digital rectal examination to assess the loss of anal tone. If at this stage the symptoms and signs are limited to low back pain and sciatica, there will be no apparent indication of cauda equina syndrome.

If there is no neurological deficit present that would be suggestive of CES, there is no mandatory requirement for an emergency MRI scan. Instead, it would be reasonable for an MRI scan to be carried out during an out-patient appointment within seven days. Importantly, however, a patient must be advised that he/she should return to immediately to hospital should neurological symptoms progress.

On the other hand if a patient does have the red flag symptoms of cauda equina syndrome, an emergency MRI scan must be performed.

Re-attendance at hospital

If a patient returns to hospital shortly after their first visit, he/she should be assessed by the most senior doctor available. This is because there is a well-recognised risk of unplanned re-attendances being due to previously undiagnosed significant conditions.

A patient should be assessed by a doctor such as the Emergency Department Consultant. This must include a detailed history and a thorough examination of the lower limbs. The doctor should also elicit whether there is any neurological deficit in terms of power, sensation and reflexes. Anal tone and perineal sensation must also be tested.

Again, if there is no suggestion of progressive neurological symptoms affecting the lower limbs/bowel/bladder, there is no mandatory requirement for an emergency MRI scan. But if there is a change in symptoms – for example, the development of urinary dysfunction or reduced perineal sensation – a scan should be performed immediately.

Failure to diagnose cauda equina syndrome

If a patient does report neurological difficulties, such as numbness between the legs, an emergency MRI scan is needed. A failure to arrange this investigation will constitute a breach of duty. If this causes a harmful delay in the diagnosis and treatment of cauda equina syndrome, there will be a case of medical negligence.

If a hospital failed to diagnose your cauda equina syndrome in a timely manner, contact us to discuss your options. You could be entitled to claim compensation.

Please call us free on 0800 234 3300, from a mobile click to call 01275 334030 or complete our Free Online Enquiry for a no cost, no obligation opinion.

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