Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain
This is an article review of “ Prospective evaluation of a clinical decision guidelines to diagnose spinal epidural abscess in the patients who present to the emergency department with spine pain” by Davis et al “.
The main objective of this prospective cohort study is to evaluate a novel clinical decision guideline to screen patients who came to emergency department(ED) with spine pain.
Spinal epidural abscess’’ is uncommon but very life threatening disorder. The incidence is 0.2 to 2.8 cases per 10,000 hospital admission. The main symptom are back pain, fever, and rooting pain. Based upon the spinal cord involvement , it lead to muscle paralysis and paraplegia.
This prospective cohort study was designed to evaluate the impact of a novel clinical decision guideline. A clinical decision guideline is a component of CDS.This study was performed in an urban university ED with approximately 45,000 annual visits. The target age of cohort is greater than 14.The incidence of diagnostic delays and presence of motor deficits at the time of SEA diagnosis before and after guidelines implementation were determined.
The study result suggests that diagnostic delays were observed in 46 (83.6%0 of 55 patient before guideline implementation versus 3 (9.7%) of 31 after guideline implementation (p<0.001).Motor deficits were present at the time of diagnosis in 45 (81.8%) of 55 patients before guidelines implementation versus 6 (19.4%) of 31 after guideline implementation.
A novel clinical decision guideline with risk assessment followed by ESR and CRP testing was highly sensitive and moderately specific to identify patients with back pain at ED.
This is only one of the few clinical decision guidelines available. This study involved only few of risk factors for risk factor assessment. There are many risk factors that lead to SEA. These risk factors should be incorporated in the future studies.
- Davis, D. P., et al. (2011). "Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain." J Neurosurg Spine 14(6): 765-770.