The diagnosis of cauda equina syndrome is a journey that involves a number of different medical professionals.
Typically a patient will first present to their GP surgery or A&E department. Subsequently he/she may see the emergency on-call service, the radiology department, the admitting team at the hospital, and finally the surgical team.
Where do problems occur in a diagnosis of CES?
Due to the number of practitioners involved in a diagnosis and the relative rarity of the condition, it is very possible that mistakes will occur along the way. Below we take a look at each medical area in closer detail, exploring why error may arise:-
1. GPs
On average GPs will only see one case of cauda equina syndrome during the course of their career. This lack of exposure makes it very likely that the condition will go unnoticed. Furthermore, GPs often fail to note a patient’s deterioration, instead persisting to continue with the same advice and treatment. There is also the risk that GPs will simply rely upon the opinion of hospital doctors, who may have previously discharged a patient with a misdiagnosis.
2. Emergency on-call service
The emergency on-call services do not always see a patient. Either way, the fact that an on-call doctor is not aware of a patient’s history, along with a lack of knowledge about CES, often means that a patient is not referred.
3. A&E
A&E departments see a large number of patients every year complaining of non-specific back pain. Because of this, doctors may fail to differentiate between generalised back pain and the red flag symptoms of cauda equina syndrome. It is usually the case that this mistake could have been prevented with a proper neurological examination.
4. Radiology
Around 75% of suspected CES patients will have a negative MRI scan. Consequently radiologists have become reluctant to carry out urgent scans for suspected CES because in the majority of cases it will be a more minor condition. Even if CES is present, there is frequently a failure to contact the referring clinician.
5. Admitting team
The admitting team may face delays due to a lack of MRI scans, delays in transfer and difficulty with referral. It may also be that case that due to a lack of knowledge, the admitting team does not appreciate the urgency with which a patient must be referred, and senior advice is not sought.
6. Surgical team
Usually once a patient has reached the surgical team, CES has been diagnosed and the need for emergency surgery is recognised. However, it is possible that there will be a delay in investigation, a delay in time to theatre, a failure to observe post-op and a failure to re-investigate CES.
Claiming for a delayed diagnosis of cauda equina syndrome
If you or your loved one has suffered complications because of a delayed diagnosis of cauda equina syndrome, you could be entitled to pursue a medico-legal claim for compensation. Contact us today to find out more.