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{ "pk": 24985, "title": "Diagnostic Delays Are Common, and Classic Presentations Are Rare in Spinal Epidural Abscess", "subtitle": null, "abstract": "<p class=\"MsoNormal\"><strong>Introduction:</strong> Spinal epidural abscess (SEA) is a rare surgical emergency of the spine that can result in permanent neurological injury if not diagnosed and treated in a timely manner. Because early presentation can appear similar to benign back or neck pain, delays in diagnosis may be relatively common. We sought an improved understanding of the characteristics associated with SEA and frequency of delays in SEA diagnosis. </p>\n<p class=\"MsoNormal\"><strong>Methods:</strong> We conducted a retrospective cohort study of adult patients with new magnetic resonance imaging-confirmed SEA from January 1, 2016–December 31, 2019 in an integrated healthcare system. We applied electronic data abstraction and focused manual chart review to describe potentially SEA-related ambulatory and emergency visits in the 30 days prior to SEA diagnosis, and patient characteristics including comorbidities, potential risk factors, and presenting signs and symptoms. We described the frequency of potential delays in diagnosis and of previously described clinical characteristics and risk factors for SEA.</p>\n<p class=\"MsoNormal\"><strong>Results:</strong> Spinal epidural abscess was diagnosed in 457 patients during the study period, 178 (39%) of whom were female, with median age 63 years (interquartile range 45-81 years). More than two-thirds of patients had at least one visit prior to diagnosis (323, 71%), and SEA location was most commonly the lumbar spine (235, 51%). Although over 90% of patients presented with back or neck pain or tenderness, the classic triad of back pain, fever, and neurologic symptoms was present in only 10% of patients. Diabetes mellitus and infection in the prior 90 days were common, while injection drug use, chronic steroid use, HIV infection, and solid organ transplant were rare.</p>\n<p class=\"MsoNormal\"><strong>Conclusion:</strong> In an integrated healthcare system, 71% of patients with spinal epidural abscess had potentially related ambulatory care or emergency visits in the 30 days prior to diagnosis. Diagnosis of SEA remains challenging, with multiple visits common before the diagnosis is clear.</p>", "language": "eng", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "spinal epidural abscess" }, { "word": "Epidural abscess" }, { "word": "diagnostic delay" } ], "section": "Neurology", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/15t8q6sk", "frozenauthors": [ { "first_name": "Edward", "middle_name": "J.", "last_name": "Durant", "name_suffix": "", "institution": "Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Clinical Sciences, Pasadena, California; The Permanente Medical Group, Department of Emergency Medicine, Pleasanton, California; Kaiser Permanente Central Valley, Department of Emergency Medicine, Modesto, California", "department": "" }, { "first_name": "Sarabeth", "middle_name": "", "last_name": "Copos", "name_suffix": "", "institution": "The Permanente Medical Group, Department of Emergency Medicine, Pleasanton, California", "department": "" }, { "first_name": "Bruce", "middle_name": "F.", "last_name": "Folck", "name_suffix": "", "institution": "Kaiser Permanente Northern California, Division of Research, Pleasanton, California", "department": "" }, { "first_name": "Meredith", "middle_name": "", "last_name": "Anderson", "name_suffix": "", "institution": "Kaiser Permanente Northern California, Division of Research, Pleasanton, California", "department": "" }, { "first_name": "Meena", "middle_name": "S.", "last_name": "Ghiya", "name_suffix": "", "institution": "The Permanente Medical Group, Department of Emergency Medicine, Pleasanton, California", "department": "" }, { "first_name": "Eric", "middle_name": "R.", "last_name": "Hofmann", "name_suffix": "", "institution": "The Permanente Medical Group, Department of Emergency Medicine, Pleasanton, California", "department": "" }, { "first_name": "Peter", "middle_name": "", "last_name": "Vuong", "name_suffix": "", "institution": "Kaiser Permanente Central Valley, Department of Emergency Medicine, Modesto, California", "department": "" }, { "first_name": "Judy", "middle_name": "", "last_name": "Shan", "name_suffix": "", "institution": "University of California San Francisco School of Medicine, Department of Clinical Sciences, San Francisco, California", "department": "" }, { "first_name": "Mamata", "middle_name": "", "last_name": "Kene", "name_suffix": "", "institution": "The Permanente Medical Group, Department of Emergency Medicine, Pleasanton, California", "department": "" } ], "date_submitted": "2024-06-28T10:59:18.495000-07:00", "date_accepted": "2024-12-19T15:05:18.782000-08:00", "date_published": "2025-02-24T09:58:00-08:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/24985/galley/36414/download/" } ] }