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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVIII | Pages 91 - 91
1 May 2012
Hindmarsh D Davenport J Selvaratnam V Ampat G
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Background

Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment, which can lead to devastating outcome on patients. The aim of this study was to assess health care professionals knowledge with regards to the urinary symptoms of CES and the timeframe in which treatment should be offered.

Objectives

To assess health care professionals knowledge with regards to urinary symptoms of CES and when treatment should be offered.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 18 - 18
1 Apr 2012
Hindmarsh D Davenport J Selvaratnam V Ampat G
Full Access

Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment, which can lead to devastating outcome on patients. The aim of this study was to assess health care professionals knowledge with regards to the urinary symptoms of CES and the timeframe in which treatment should be offered.

To assess health care professionals knowledge with regards to urinary symptoms of CES and when treatment should be offered.

A 4-part questionnaire established profession and number of cases seen per week. The participant was asked to rank 15 urinary symptoms, 7 of these symptoms were not related to CES. The participants were asked the ideal time to surgical intervention for Complete CES and Incomplete CES.

Primary and Secondary Care

60 questionnaires were complete. Participants had to successfully complete the first three parts of the questionnaire (n = 44). Any who failed to complete section four were excluded from analysis from that part only (n = 41).

A total of 44 questionnaires were analysed. Both doctors and physiotherapists ranked the CES symptoms on average significantly higher than then the non-CES symptoms. The physiotherapists rated the CES symptoms significantly higher than the doctors (P = 0.05) and on average rated the non-CES symptoms significantly lower than doctors (P < 0.05).

87.8% thought that complete CES should be treated < 24 hours and 9.76% thought that complete CES should be treated from 24-48 hours. 46.34% thought that CESI should be treated < 24 hours and 43.9% thought that CESI should be treated from 24-48 hours.

These results demonstrate that physiotherapists are better than Doctors at identifying the urinary symptoms in CES. The majority of health care professional who took part in this study stated that they would offer surgical intervention for both Complete and Incomplete CES within 24 hours. The gap in knowledge highlights the need for education to all medical professionals in the symptoms of CES and also the timing of treatment.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 44 - 44
1 Jan 2012
Hindmarsh D Davenport J Selvaratnam V Ampat G
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Objectives

To assess health care professional's knowledge with regards to the urinary symptoms of CES and when treatment should be offered.

Background

Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 52 - 52
1 Jan 2012
Hindmarsh D Manickavasagar T Davenport J Ampat G
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Introduction:

“Spine Class” was organised at Southport Hospitals NHS Trust. The course was awarded 6 CPD (Continuing Professional Development) points. We propose a new method for assessing the effectiveness of educational courses by pre and post testing and participant satisfaction.

Materials and Methods

The course was attended by 64 delegates (49 Allied Health Professionals e.g. Physiotherapists and 15 Physicians). 21 lectures were planned for the day. The lecturers were asked to submit 2 True/False questions (TFQs), a total of 42 questions. Questions were answered prior to the course and immediately after. The lectures were evaluated on a scale of 1 to 5.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 196 - 196
1 May 2011
Hindmarsh D Davenport J Selvaratnam V Ampat G
Full Access

Introduction: Recent articles in the MPS Casebook (Cauda equina syndrome, Gardner and Morley) and BMJ (Cauda Equina Syndrome, Lavy) highlighted the potential dangers of Cauda equina syndrome (CES). CES has the highest rates of litigation due to the risk of symptoms not resolving and having a devastating impact on patients. This study aimed to assess clinician knowledge of the urinary symptoms of CES and the timeframe in which treatment should be offered.

Method: A 4 part questionnaire was constructed. The first part established the status and type of health care professional. The second part assesses how many musculoskel-etal patients are seen in an average week. In the third part the participant is asked to rank 15 urinary symptoms; with 1 being the least alarming and 15 being the most alarming. 7 of the symptoms were not related to CES and so should have been ranked in the bottom seven. Lastly, to highlight an issue raise in the BMJ article; the participants were asked the ideal time to surgical intervention for Complete CES and Incomplete CES, with the options being within 24 hours; 24–48 hours; and 48 hours to 2 weeks. The questionnaire was distributed to Health Care Professionals in Southport and Ormskirk Hospital.

Results: The questionnaire was completed by 23 participants (12 Doctors and 11 Physiotherapists). 90.91% of Physiotherapists and 10 Doctors (83.3%) managed to complete the questionnaire as specified. An average of 24 patients was seen by each professional (25 patients doctors; 31 patients Physiotherapist). The 7 false CES urinary symptoms were ranked in the bottom 7 in 76.40% of questionnaires (77.92% in Doctors; 81.82% in Physiotherapists). True CES urinary symptoms were ranked in the bottom 7 in 59.63% of cases (66.23% Doctors; 58.44% Physiotherapists). Finally 91.30% of those asked thought Complete CES should be treated within 24 hours (83.33% Doctors; 100% Physiotherapist); 56.52% thought Incomplete CES should be treated within 24 hours (66.67% Doctors; 45.45% Physiotherapists); 30.43% within 24 to 48 hours (8.33% Doctors; 54.55% Physiotherapists) and lastly 13.04% thought Incomplete CES should be treated within 2 weeks (25% Doctors and 0% of Physiotherapists).

Conclusion: The results show that there is a gap in knowledge of all professional with regards to CES urinary symptoms and the optimal timing of treatment. The results showed that Physiotherapists are more likely to recognise True CES than doctors. False symptoms were ranked lower by Physiotherapists than Medical Professionals. These results demonstrate that physiotherapists are better than Doctors at identifying urinary symptoms in CES. Finally the majority of those asked would treat Complete and Incomplete CES within 24 hours. The gap in knowledge highlights the need for education to all medical personnel in the symptoms of Cauda Equina Syndrome and also the timing of treatment.