title: Management of metastatic spinal cord compression: awareness of NICE guidance.
abstract: OBJECTIVE
  The spine is the most common site for bony metastases. It can lead to the development of significant complications and morbidity if appropriate treatment is not provided. National Institute for Health and Clinical Excellence (NICE) issued new guidance in 2008 with regard to the management of patient with metastatic spinal cord compression (MSCC) to assess the awareness of the NICE guidelines for MSCC.
  
  
  METHODS
  We contacted doctors in oncology, trauma and orthopaedics, palliative care and general medicine and assessed their knowledge of MSCC using a questionnaire based on the salient points of the NICE guidance. This was a UK-wide questionnaire.
  
  
  RESULTS
  We contacted 96 trainee doctors (oncology, palliative care, general medicine and orthopaedics) and found that 74 % felt adequately informed to diagnose metastatic cord compression although only 11 % considered a sensory level as a potential sign of cord compression. Neurological symptoms (91 %) were the main reason for referral to a tertiary spinal service. MRI was the investigation of choice. There was a poor knowledge of metastatic scoring systems and only 8 % would consider assessing the patient's fitness for surgery. Most of the respondents felt that they had been poorly taught at undergraduate and postgraduate level on MSSC.
  
  
  CONCLUSIONS
  Our audit shows that MSCC is poorly understood in general and that greater understanding of the NICE guidance is required to allow for better management of these patients and more prompt referral for appropriate surgical assessment.
authors.affiliation: University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK, brooks.francis@gmail.com.
authors.forename: F M
authors.initials: FM
authors.lastname: Brooks
authors.forename: Ameet
authors.initials: A
authors.lastname: Ghatahora
authors.forename: M C
authors.initials: MC
authors.lastname: Brooks
authors.forename: Hazel
authors.initials: H
authors.lastname: Warren
authors.forename: Laura
authors.initials: L
authors.lastname: Price
authors.forename: Pranter
authors.initials: P
authors.lastname: Brahmabhatt
authors.forename: Saik
authors.initials: S
authors.lastname: De Vauvert
authors.forename: Cerys
authors.initials: C
authors.lastname: John
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Farnworth
authors.forename: Erwina
authors.initials: E
authors.lastname: Sulaiman
authors.forename: Sashin
authors.initials: S
authors.lastname: Ahuja
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D009985:Orthopedics / Q000592:standards*; D065126:Palliative Medicine / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D013117:Spinal Cord Compression / Q000209:etiology / Q000628:therapy*; D013125:Spinal Neoplasms / Q000556:secondary* / Q000628:therapy; D006113:United Kingdom