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Identification of cauda equina syndrome (12HDC01291)
Download Identification of cauda equina syndrome (12HDC01291) (PDF 69Kb)
(12HDC01291, 16 June
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
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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