What question did this study set out to answer?

To quantify the number of healthcare professionals reviewing patients with suspected cauda equina syndrome and assess compliance with the South Wales Spinal Network pathway.

March 29, 2026

SRS293 - Too many cooks? The impact of multiple reviews on Cauda Equina pathway delays

Key Points

To quantify the number of healthcare professionals reviewing patients with suspected cauda equina syndrome and assess compliance with the South Wales Spinal Network pathway.
Retrospective review of data from the South Wales Spinal Network
Included patients over 16 years with suspected cauda equina syndrome
Data collection on timelines from symptom onset to MRI and number of healthcare professional assessments
157 patients included, with some presenting more than 14 days after symptom onset
Median time from first contact to MRI varied across trusts, from 5.3 to 15.5 hours
60.9% of patients were assessed by multiple healthcare professionals pre-MRI
Radiological confirmation of cauda equina syndrome was seen in 9.6% of cases
Pathway compliance varied, with some trusts showing 0% compliance and others ranging from 3.57% to 52%

Abstract

Abstract Background Cauda Equina Syndrome (CES) is a neurosurgical emergency requiring urgent intervention; diagnostic delay can have severe consequences. This study audited the CES pathway across South Wales hospitals. The primary aim was to quantify the number of competent healthcare professionals (HCPs) reviewing patients prior to MRI. The secondary aim was to assess the patient journey and identify deviations from the South Wales Spinal Network pathway. Methods A retrospective review was performed using South Wales Spinal Network data. Patients 16 years presenting with suspected CES from any referral source were included. Exclusions were isolated radicular pain without bladder/bowel disturbance and metastatic spinal cord compression. Data collected included time from symptom onset to presentation, number of HCPs seen pre-MRI, and MRI timing. Results A total of 157 patients were included. A proportion presented 14 days after symptom onset. Most first attended GPs or Emergency Departments. Median time from first contact to MRI varied: ABUHB 10.15h, CTMUHB 15.5h, SBUHB 8.6h, C&VUHB 5.3h. Multiple HCPs assessed 60.9% of patients pre-MRI, potentially delaying diagnosis. Mean HCPs per trust were: ABUHB 2.0, CTMUHB 1.6, SBUHB 2.4, C&VUHB 1.3. CES was radiologically confirmed in 9.6%. Pathway compliance varied: two trusts were 0% compliant, others 3.57% and 52%, with individual step compliance ranging 0–89.3%. Conclusions Delays in CES diagnosis persist, particularly regarding MRI access. Variation in pre-imaging reviews suggests inefficiencies. Improved MRI availability, streamlined referral pathways, and consistent regional standards are required to optimise outcomes.

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