SRS293 - Too many cooks? The impact of multiple reviews on Cauda Equina pathway delays

Abstract Background Cauda Equina Syndrome (CES) is a neurosurgical emergency requiring urgent intervention; diagnostic delay can have severe consequences. This study audited the CES pathway across South Wales hospitals. The primary aim was to quantify the number of competent healthcare professionals (HCPs) reviewing patients prior to MRI. The secondary aim was to assess the patient journey and identify deviations from the South Wales Spinal Network pathway. Methods A retrospective review was performed using South Wales Spinal Network data. Patients >16 years presenting with suspected CES from any referral source were included. Exclusions were isolated radicular pain without bladder/bowel disturbance and metastatic spinal cord compression. Data collected included time from symptom onset to presentation, number of HCPs seen pre-MRI, and MRI timing. Results A total of 157 patients were included. A proportion presented >14 days after symptom onset. Most first attended GPs or Emergency Departments. Median time from first contact to MRI varied: ABUHB 10.15h, CTMUHB 15.5h, SBUHB 8.6h, C&VUHB 5.3h. Multiple HCPs assessed 60.9% of patients pre-MRI, potentially delaying diagnosis. Mean HCPs per trust were: ABUHB 2.0, CTMUHB 1.6, SBUHB 2.4, C&VUHB 1.3. CES was radiologically confirmed in 9.6%. Pathway compliance varied: two trusts were 0% compliant, others 3.57% and 52%, with individual step compliance ranging 0–89.3%. Conclusions Delays in CES diagnosis persist, particularly regarding MRI access. Variation in pre-imaging reviews suggests inefficiencies. Improved MRI availability, streamlined referral pathways, and consistent regional standards are required to optimise outcomes.