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Identification of cauda equina syndrome (12HDC01291)

Download Identification of cauda equina syndrome (12HDC01291) (PDF 69Kb)

(12HDC01291, 16 June 2014)

General practitioner ~ Accident and medical clinic ~ Investigation ~ Referral ~ Follow-up ~ Cauda equina syndrome ~ Rights 4(1), 4(4)

A man was lifting heavy items when he began to suffer lower back pain. This increased in severity during the day to the extent that he had severe pains, cramping and "pins and needles" sensations down his right leg.

The following day he went to see a general practitioner (GP) at an accident and medical centre about the pain. He told the GP that he had a history of back problems. The GP advised HDC that, as the man was presenting with similar symptoms to those he had experienced previously, he (the GP) concluded that the man had "a right 5th lumbar nerve sciatica, moderate to severe in nature". The GP documented in the man's medical notes that he should return to physiotherapy and to his usual GP for follow-up.

The GP did not give the man advice to seek medical help immediately should his symptoms deteriorate or if new symptoms such as bladder or bowel problems should develop. The following day the man went to hospital, as he "was in excruciating pain". He was examined and a provisional diagnosis of suspected cauda equina syndrome was made. The man was immediately referred to the orthopaedic department, and underwent emergency surgery that afternoon, where the diagnosis of cauda equina syndrome was confirmed.

It was found that the GP failed to recognise the red flags in the man's presentation, to investigate his symptoms, to identify the man's possible diagnosis of cauda equina syndrome, and to refer him for urgent clinical review. He therefore breached Right 4(1). Furthermore, by not advising the man to seek further assistance immediately if his symptoms worsened, the GP did not take all reasonable steps to ensure that the man was provided services in a manner that minimised the potential harm to him. Therefore, the GP also breached Right 4(4).

Adverse comment was made regarding the GP's failure to document the man's presentation comprehensively, and also about the accident and medical centre's failure to have in place a policy regarding the assessment and management of lower back pain. 

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