Sai Viswan Thiagarajah, Edward Cornish, Amit Kapoor, Jeremy Telford, Thomas Langstroth, Kenneth Koo
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引用次数: 0
Abstract
Background: Cauda equina syndrome (CES) is a rare but serious neurosurgical emergency. Back pain and sciatica are common presentations to A&E. Get It Right First Time (GIRFT) published guidance in February 2023 regarding the red flag symptoms and symptom duration requiring emergency MRI. This framework has been utilised by the orthopaedic service within our hospital. The aim of this study was to assess whether implementing GIRFT guidance could reduce CES related admissions without impacting the diagnostic yield for identifying this emergency.Methods: Retrospective review of all emergency MRI scans to exclude CES during two 6-month periods. GIRFT guidance was published in February 2023. Period 1 (01/08/2022-31/01/2023) was prior to GIRFT guidance and period 2 (01/08/2024-31/01/2025) was more than 1 year after GIRFT guidance. Statistical analysis was undertaken using Chisquared and Mann-Whitney testing. Results: There were 175 emergency MRI scans to exclude CES during period 1 versus 159 during period 2. After implementation of GIRFT guidance, there was a significant reduction in the percentage of patients requiring admission (42.77% vs 56.57%, p = 0.016) and an increase in the percentage of patients scanned on the day of presentation (61.64% vs 52.57%, p = 0.119). There was no change in the diagnostic yield of scans for identifying CES (4.57% vs 4.4%, p = 1). Conclusion: Our results show that utilisation of the GIRFT guidance reduced CES related admissions without negatively impacting diagnostic yield. These findings highlight the value of implementing GIRFT guidelines in neurosurgical and orthopaedic departments across the country.
背景:马尾综合征是一种罕见但严重的神经外科急症。背部疼痛和坐骨神经痛是急诊室常见的症状。2023年2月,GIRFT发布了关于红旗症状和需要紧急MRI的症状持续时间的指南。该框架已被我们医院的骨科服务所采用。本研究的目的是评估实施GIRFT指南是否可以在不影响识别这种紧急情况的诊断率的情况下减少与CES相关的入院。方法:回顾性分析两个6个月期间所有紧急MRI扫描以排除CES。GIRFT指南于2023年2月发布。第一阶段(2022年8月1日至2023年1月31日)是在GIRFT指导之前,第二阶段(2024年8月1日至2025年1月31日)是在GIRFT指导之后一年多。采用chisqusquared检验和Mann-Whitney检验进行统计分析。结果:在第一阶段有175次紧急MRI扫描排除了CES,而在第二阶段有159次。实施GIRFT指导后,需要住院的患者比例显著降低(42.77% vs 56.57%, p = 0.016),就诊当天扫描的患者比例增加(61.64% vs 52.57%, p = 0.119)。扫描识别CES的诊断率没有变化(4.57% vs 4.4%, p = 1)。结论:我们的研究结果表明,使用GIRFT指南减少了与CES相关的入院,而不会对诊断率产生负面影响。这些发现强调了在全国神经外科和骨科实施GIRFT指南的价值。
期刊介绍:
NRJ - The Neuroradiology Journal (formerly Rivista di Neuroradiologia) is the official journal of the Italian Association of Neuroradiology and of the several Scientific Societies from all over the world. Founded in 1988 as Rivista di Neuroradiologia, of June 2006 evolved in NRJ - The Neuroradiology Journal. It is published bimonthly.