Symptom-only cauda equina syndrome: A medicolegal assessment of new national guidelines

Abstract

National guidelines and the legal standard of care for the management of cauda equina syndrome (CES) patients in primary care have recently changed. Any patient with a history of symptoms of CES must be referred to secondary care for urgent MR imaging (MRI) even in the absence of any objective signs of CES. This article reviews the prevalence and clinical diagnosis of CES, the new national guidelines and management in primary care. The standard of care for doctors, the legal basis of national guidelines and an illustrative judgement are discussed. This new standard of care for GPs will make it easier for claimants to demonstrate a breach of duty of care and, because patients should be referred earlier (on the basis of symptoms not signs of CES), causation and quantum will be higher than for cases where MR imaging and surgery are delayed until the onset of objective signs.