诊断延迟是常见的,典型的表现是罕见的脊髓硬膜外脓肿。

IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE
Edward J Durant, Sarabeth Copos, Bruce F Folck, Meredith Anderson, Meena S Ghiya, Erik R Hofmann, Peter Vuong, Judy Shan, Mamata Kene
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引用次数: 0

摘要

脊髓硬膜外脓肿(SEA)是一种罕见的脊柱外科急症,如果不及时诊断和治疗,可导致永久性神经损伤。由于早期表现可能类似于良性的背部或颈部疼痛,诊断延迟可能相对常见。我们试图更好地了解与SEA相关的特征和SEA诊断延迟的频率。方法:我们对2016年1月1日至2019年12月31日在综合医疗系统中新核磁共振成像确诊的成年SEA患者进行了回顾性队列研究。我们采用电子数据提取和重点手工图表回顾来描述在SEA诊断前30天内可能与SEA相关的门诊和急诊就诊情况,以及患者特征,包括合并症、潜在危险因素和表现的体征和症状。我们描述了潜在诊断延迟的频率以及先前描述的SEA的临床特征和危险因素。结果:在研究期间,457例患者被诊断为脊髓硬膜外脓肿,其中178例(39%)为女性,中位年龄63岁(四分位数范围45-81岁)。超过三分之二的患者在诊断前至少有一次就诊(323例,71%),SEA的位置最常见的是腰椎(235例,51%)。虽然超过90%的患者表现为背部或颈部疼痛或压痛,但只有10%的患者出现背痛、发烧和神经系统症状的经典三联征。前90天内糖尿病和感染较为常见,而注射药物使用、慢性类固醇使用、HIV感染和实体器官移植较为罕见。结论:在综合医疗保健系统中,71%的脊髓硬膜外脓肿患者在诊断前30天内接受过可能相关的门诊治疗或急诊。SEA的诊断仍然具有挑战性,在诊断明确之前多次就诊是常见的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnostic Delays Are Common, and Classic Presentations Are Rare in Spinal Epidural Abscess.

Introduction: Spinal epidural abscess (SEA) is a rare surgical emergency of the spine that can result in permanent neurological injury if not diagnosed and treated in a timely manner. Because early presentation can appear similar to benign back or neck pain, delays in diagnosis may be relatively common. We sought an improved understanding of the characteristics associated with SEA and frequency of delays in SEA diagnosis.

Methods: We conducted a retrospective cohort study of adult patients with new magnetic resonance imaging-confirmed SEA from January 1, 2016-December 31, 2019 in an integrated healthcare system. We applied electronic data abstraction and focused manual chart review to describe potentially SEA-related ambulatory and emergency visits in the 30 days prior to SEA diagnosis, and patient characteristics including comorbidities, potential risk factors, and presenting signs and symptoms. We described the frequency of potential delays in diagnosis and of previously described clinical characteristics and risk factors for SEA.

Results: Spinal epidural abscess was diagnosed in 457 patients during the study period, 178 (39%) of whom were female, with median age 63 years (interquartile range 45-81 years). More than two-thirds of patients had at least one visit prior to diagnosis (323, 71%), and SEA location was most commonly the lumbar spine (235, 51%). Although over 90% of patients presented with back or neck pain or tenderness, the classic triad of back pain, fever, and neurologic symptoms was present in only 10% of patients. Diabetes mellitus and infection in the prior 90 days were common, while injection drug use, chronic steroid use, HIV infection, and solid organ transplant were rare.

Conclusion: In an integrated healthcare system, 71% of patients with spinal epidural abscess had potentially related ambulatory care or emergency visits in the 30 days prior to diagnosis. Diagnosis of SEA remains challenging, with multiple visits common before the diagnosis is clear.

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来源期刊
Western Journal of Emergency Medicine
Western Journal of Emergency Medicine Medicine-Emergency Medicine
CiteScore
5.30
自引率
3.20%
发文量
125
审稿时长
16 weeks
期刊介绍: WestJEM focuses on how the systems and delivery of emergency care affects health, health disparities, and health outcomes in communities and populations worldwide, including the impact of social conditions on the composition of patients seeking care in emergency departments.
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