GIRFT guidance reduces cauda equina syndrome (CES) related admissions without negatively impacting diagnosis

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.