title: Diagnosis of spinal cord compression in nontrauma patients in the emergency department.
abstract: OBJECTIVE
  The objectives were to evaluate the presenting signs and symptoms of spinal cord and cauda equina compression (SCC) and to determine the incidence of emergency department (ED) misdiagnosis.
  
  
  METHODS
  This was a retrospective chart review at an urban, tertiary care hospital of patients discharged from an inpatient stay (April 2008 through July 2009) with an International Classification of Diseases, Ninth Revision (ICD-9) code indicating spinal disease, who had visited the ED for a related complaint within the previous 30 days, and who had a final diagnosis of new SCC. Trauma and transferred patients were excluded. The authors defined a misdiagnosis as no ED-documented diagnosis of SCC and failure to perform an appropriate diagnostic study either prior to arrival, in the ED, or immediately upon admission.
  
  
  RESULTS
  Of 1,231 charts reviewed, 63 met inclusion criteria. The most common presenting symptoms in patients with SCC were pain (44, 70%), difficulty ambulating (38, 60%), and weakness (35, 56%). On physical examination, motor deficits (45, 71%) were more common than sensory deficits (27, 43%); however, 15 (24%) patients had no motor or sensory deficit, and 13 (23%) patients only had unilateral findings. Impaired gait was present in 14 patients of only 20 tested, three of whom had no associated motor or sensory deficit. SCC was misdiagnosed in 18 (29%, 95% confidence interval [CI] = 19% to 41%) cases, which resulted in a significant delay to diagnosis (median = 54 hours, interquartile range [IQR] = 38 to 77 vs. 5.3 hours, IQR = 3.0 to 15) in these patients.
  
  
  CONCLUSIONS
  SCC can have a subtle presentation with absent or unilateral motor and sensory deficits, but gait ataxia may be an additional finding. ED misdiagnosis of SCC in nontrauma patients is common.
authors: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. adugas1@jhmi.edu
authors: Andrea F
authors: AF
authors: Dugas
authors: Jason M
authors: JM
authors: Lucas
authors: Jonathan A
authors: JA
authors: Edlow
mesh_terms: D000368:Aged; D002420:Cauda Equina; D002574:Cervical Vertebrae; D015897:Comorbidity; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D020234:Gait Ataxia / Q000209:etiology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis; D008159:Lumbar Vertebrae; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000175:diagnosis; D055009:Spondylosis / Q000150:complications / Q000175:diagnosis