Cauda equina syndrome in the emergency department: a 2-year retrospective review

Abstract

Cauda equina syndrome if a rare but life-changing clinical condition in
which pressure is exerted on the group of nerve roots known collectively
as cauda equina.
It was first described in 1934. It has an incident ranging from 2.7 to
4.0 per 100,000.
It is more common in women with a mean age of 42 years.
It can lead to loss of control of pelvic organs and legs, with a risk of
permanent loss of sensory and motor control in the area supplied by the
cauda equina.
The setting for the study was the emergency department in a Large
Urban Teaching Hospital. A Retrospective Chart Review over 2 years
from January 2022 to December 2023 was conducted. Adult patients
aged 18 years and over presenting with suspected cauda equina syndrome
(CES) were included. We found a CES prevalence of 0.07% of all ED
attendances or 74 per 100,000. There was a female preponderance of
70% versus 30% male. A total of 74% of cases were aged between 24
and 65 years at one peak, and a spike after the age of 75 years. Most
cases (92%) were managed conservatively. A total of 100 patients (68%)
were admitted or transferred, while 32% were discharged. A total of 140
patients (95%) met the National Institute for Health and Care Excellence
(NICE) red flag symptoms.

In conclusion, CES is rare (< 0.5% of ED presentations). There was an
age peak between 25 and 65 years, with a spike after the age of 75 years.
It has a large female preponderance in keeping with the observation from
other studies. Ninety five per cent of cases in our cohort met the NICE
red flag criteria. Most cases were managed locally and conservatively.