Just the Facts: Risk stratifying non-traumatic back pain for spinal epidural abscess in the emergency department

Zoe Polsky, Shawn K. Dowling, W. Bradley Jacobs
2020 CJEM: Canadian Journal of Emergency Medical Care  
A 65-year-old male with a history of hypertension presents to the emergency department (ED) with new onset of non-traumatic back pain. The patient is investigated for life-threatening diagnoses and screened for "red flag symptoms," including fever, neurologic abnormalities, bowel/bladder symptoms, and a history of injectiondrug use (IVDU). The patient is treated symptomatically and discharged home but represents to the ED three additional times, each time with new and progressive symptoms. At
more » ... e time of admission, he is unable to ambulate, has perineal anesthesia, and 500 cc of urinary retention. Whole spine magnetic resonance imaging (MRI) confirms a thoracic spinal epidural abscess. This case, and many like it, prompts the questions: when should emergency physicians consider the diagnosis of a spinal epidural abscess, and what is the appropriate evaluation of these patients in the ED? (Figure 1).
doi:10.1017/cem.2020.422 pmid:32674746 fatcat:utxpqjf5v5d73es7l4wbj3uz5m