GP Failure to Diagnose Cauda Equina Syndrome

If a GP fails to recognise the red flag symptoms of cauda equina syndrome, resulting in a delay in surgical intervention, there could be grounds for a compensation claim.

Red flags of cauda equina compression

At the end of the spinal cord is a bundle of nerves called the cauda equina, so called because early anatomists thought it resembled a horse’s tail. The cauda equina nerves serve the perineum, sexual organs, bladder and bowel, enabling sensation and function.

It is possible for the cauda equina nerves to become compressed, either by surrounding structures (such as a slipped disc), a growth or lesion (such as a spinal tumour), or an infection/inflammation that narrows the spinal canal, reducing the space in which the nerves sit.

If the nerves are compressed, they will become injured and function will gradually be lost. This will result in a collection of symptoms that will quickly deteriorate over a matter of hours. These symptoms are called the red flag symptoms of cauda equina syndrome (CES) and include:-

• Chronic back pain
• Bilateral sciatica
• Weakness and numbness in the legs
• Perineal numbness
• Difficulty with urinary function
• Bowel dysfunction

Recognising cauda equina compression

If a patient presents to their GP with these symptoms, a GP should recognise them as being indicative of cauda equina compression. Tests and examinations can help to confirm a diagnosis and rule out other possible conditions.

For example, a digital rectal examination will reveal poor anal tone, while a straight leg raise test will show severe restriction. Both of these things point towards cauda equina syndrome. On the other hand, a blood test and urine test will not display a raised CRP count/a raised white blood cell count, dismissing the possibility of infection.

The combination of a patient’s symptoms and the examination/test results should set alarm bells ringing, as these are objective signs of CES. A GP should therefore urgently refer a patient for a surgical review in hospital.

GP failure to recognise CES

Unfortunately, however, GPs often fail to refer a patient with cauda equina syndrome. This largely occurs because of a lack of knowledge. On average, a GP will only see one case of cauda equina syndrome during their careers, meaning they do not even consider the possibility of nerve compression when presented with the red flags of CES. Furthermore, there may be poor monitoring of a patient’s condition, causing the progression of symptoms to go unnoticed.

Another common problem is that a patient may already have been to A&E for their symptoms and been discharged with a misdiagnosis. GPs often fail to challenge diagnoses made by hospitals, and instead rely upon the opinion of hospital doctors.

Claiming against a GP

It is not acceptable for GPs to overlook the red flag symptoms of cauda equina syndrome. GPs in the UK should be able to recognise a patient’s symptoms as being characteristic of spinal nerve compression and refer him/her to hospital for a specialist opinion. A failure to do so will amount to a substandard level of care. If this causes a patient unnecessary harm, there will be grounds for a compensation claim. Contact us today to find out more.

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