Wong Yiu Nam, Li Hak Suen, Kwok Sin To
United Christian Hospital Department of Accident and Emergency Hong Kong.
United Christian Hospital Department of Orthopaedics and Traumatology Hong Kong.
J Acute Med. 2023 Mar 1;13(1):12-19. doi: 10.6705/j.jacme.202303_13(1).0003.
Spinal epidural abscess (SEA) is an uncommon but serious differential diagnosis of acute spinal pain with high paralysis and mortality rate. This study aims to provide local data on its bioclinical characteristics and evaluate potential strategies to enhance its diagnostic rate in accident and emergency department (AED).
A retrospective case study from 2013 to 2019 was conducted in United Christian Hospital. SEA cases were classified as study group, spinal pain due to non-SEA cases were classified as control group. Data collected from study group included symptoms, radiological diagnosis, microbiological culture, treatment, and outcome. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) of both groups were compared to analyze their diagnostic power.
In the study group (n = 42), 93% of patients had spinal pain, 55% had fever, 60% had neurological deficits, and only 26% had the classic triad on presentation. Seventy-four percent of patients presented with spinal cord or cauda equina compression in their first magnetic resonance imaging. Mortality rate was 23.8%, and paralysis rate was 7.1%. Diagnostic accuracy in AED was 12%. Admission to orthopedic ward (n = 23) resulted in a significantly lower mean time-to-imaging (4.39 days vs. 14.58 days) and mean time-to-treatment (6.56 days vs. 16.9 days) as compared to other specialties. The area under curves of CRP and ESR were 0.893 and 0.874 respectively, the optimal threshold levels were 45.9 mg/L (sensitivity 82.9%, specificity 79%) and 59.5 mm/hr (sensitivity 87.2%, specificity 80.4%), respectively.
Diagnosis of SEA in emergency department based on clinical symptomatology is not reliable due to low incidence of the classic triad, despite a more advanced disease on presentation. We proposed incorporating CRP and ESR tests into evaluation of patients with spinal pain since both tests demonstrated excellent discriminative power in diagnosing SEA.
脊柱硬膜外脓肿（SEA）是急性脊柱疼痛的一种罕见但严重的鉴别诊断，具有较高的瘫痪率和死亡率。本研究旨在提供有关其生物临床特征的本地数据，并评估提高急诊科（AED）诊断率的潜在策略。
在联合医院进行了一项2013年至2019年的回顾性病例研究。SEA病例被分类为研究组，非SEA病例引起的脊柱疼痛被分类为对照组。从研究组收集的数据包括症状、放射学诊断、微生物培养、治疗和结果。比较两组的C反应蛋白（CRP）和红细胞沉降率（ESR），以分析它们的诊断能力。
在研究组（n = 42）中，93%的患者有脊柱疼痛，55%的患者有发热，60%的患者有神经功能缺损，初诊时只有26%的患者有典型三联征。74%的患者在首次磁共振成像时出现脊髓或马尾受压。死亡率为23.8%，瘫痪率为7.1%。急诊科的诊断准确率为12%。与其他专科相比，入住骨科病房（n = 23）导致平均成像时间（4.39天对14.58天）和平均治疗时间（6.56天对16.9天）显著缩短。CRP和ESR的曲线下面积分别为0.893和0.874，最佳阈值水平分别为45.9 mg/L（敏感性82.9%，特异性79%）和59.5 mm/hr（敏感性87.2%，特异性80.4%）。
尽管初诊时病情更严重，但由于典型三联征的发生率低，基于临床症状在急诊科诊断SEA并不可靠。我们建议将CRP和ESR检测纳入脊柱疼痛患者的评估中，因为这两项检测在诊断SEA方面都显示出出色的鉴别能力。
