Post-void bladder scanning in acute cauda equina syndrome
Research type
Research Study
Full title
A Study into the use of Post-Void Bladder Scanning as Part of a Clinical Algorithm for the Assessment of Patients with Suspected Acute Cauda Equina Syndrome
IRAS ID
205655
Contact name
Oliver Stokes
Contact email
Sponsor organisation
Royal Devon & Exeter NHS Foundation Trust
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Acute cauda equina syndrome is a relatively rare but potentially devastating spinal surgical emergency. Patient presentation is variable and therefore diagnosing CES based on clinical features can be unreliable and subjective. Magnetic resonance imaging (MRI) provides definitive evidence of CES, however the majority of patients who undergo this investigation do not demonstrate cauda equina compression and therefore do not require surgery. Urgent use out of hours MRI scanning for these patients is expensive, wasteful and places strain on limited NHS resources.
The aim of this study is to test a clinical algorithm which employs both clinical examination and ultrasound bladder scanning to stratify patients into high and low risk groups of having acute CES. By determining the likelihood of acute CES, clinicians may be able to ration the use of out of hours emergency MRI more effectively.
All patients presenting to the Royal Devon and Exeter NHS Foundation Trust with suspected acute CES who meet our pre-defined inclusion criteria will be included in this study. Appendix 1 outlines the algorithm that will be followed. Patients with normal perianal sensation and residual urine volume (volume of urine left in the bladder) less than 100ml will be classified as low risk and receive MRI as an outpatient within one working week, whereas those with abnormal perianal sensation or residual urine volume greater than 100ml will be deemed high risk and undergo urgent MRI. This algorithm has been employed in the clinical practice of the lead investigator for the past 26 months, in which time no patient has come to any harm from its application.
The findings of this study may allow more objective stratification of CES risk and therefore result in more efficient rationing of valuable healthcare resources.
REC name
South West - Frenchay Research Ethics Committee
REC reference
16/SW/0216
Date of REC Opinion
18 Sep 2016
REC opinion
Unfavourable Opinion