High risk and low prevalence diseases: Spinal epidural abscess
Brit Long, Jestin Carlson, Tim Montrief, Alex Koyfman
Introduction: Spinal epidural abscess (SEA) is a rare but serious condition that carries with it a high rate of morbidity and mortality. Objective: This review highlights the pearls and pitfalls of SEA, including presentation, initial evaluation, and management in the emergency department (ED) based on current evidence. Discussion: SEA is a suppurative infection and infectious disease emergency that may result in significant morbidity and even mortality. It is a challenging diagnosis due to its range of risk factors and variety of presentations with up to 90% of patients misdiagnosed on their first ED visit. Factors associated with increased risk of SEA include immunocompromise, bacteremia, contiguous infection (e.g., psoas muscle abscess, osteomyelitis, skin infection), and spinal instrumentation. However, the absence of risk factors cannot be used to exclude SEA. The classic triad of back pain, fever, and neurologic deficit occurs in less than 8% of cases, though back pain is a common presenting symptom. Up to half of patients experience a neurologic abnormality, but fever is absent in 50%. Laboratory assessment may assist with inflammatory markers elevated in the majority of cases. Diagnosis includes magnetic resonance imaging with and without contrast and blood cultures, and management includes spinal specialist consultation and antibiotic therapy. Conclusions: An understanding of SEA can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
American Journal of Emergency Medicine
https://doi.org/10.1016/j.ajem.2022.01.008
10.1016/j.ajem.2022.01.008
Dive into the research topics of 'High risk and low prevalence diseases: Spinal epidural abscess'. Together they form a unique fingerprint.
Epidural Abscess Medicine & Life Sciences 100%
Back Pain Medicine & Life Sciences 24%
Hospital Emergency Service Medicine & Life Sciences 18%
Psoas Abscess Medicine & Life Sciences 17%
Fever Medicine & Life Sciences 17%
Psoas Muscles Medicine & Life Sciences 16%
Long, B., Carlson, J., Montrief, T., & Koyfman, A. (2022). High risk and low prevalence diseases: Spinal epidural abscess. American Journal of Emergency Medicine, 53, 168-172. https://doi.org/10.1016/j.ajem.2022.01.008
High risk and low prevalence diseases : Spinal epidural abscess. / Long, Brit; Carlson, Jestin; Montrief, Tim et al.
In: American Journal of Emergency Medicine, Vol. 53, 03.2022, p. 168-172.
Long, B, Carlson, J, Montrief, T & Koyfman, A 2022, 'High risk and low prevalence diseases: Spinal epidural abscess', American Journal of Emergency Medicine, vol. 53, pp. 168-172. https://doi.org/10.1016/j.ajem.2022.01.008
Long B, Carlson J, Montrief T, Koyfman A. High risk and low prevalence diseases: Spinal epidural abscess. American Journal of Emergency Medicine. 2022 Mar;53:168-172. doi: 10.1016/j.ajem.2022.01.008
Long, Brit ; Carlson, Jestin ; Montrief, Tim et al. / High risk and low prevalence diseases : Spinal epidural abscess. In: American Journal of Emergency Medicine. 2022 ; Vol. 53. pp. 168-172.
@article{07a2f220887e4a618b035c16de81a77d,
title = "High risk and low prevalence diseases: Spinal epidural abscess",
abstract = "Introduction: Spinal epidural abscess (SEA) is a rare but serious condition that carries with it a high rate of morbidity and mortality. Objective: This review highlights the pearls and pitfalls of SEA, including presentation, initial evaluation, and management in the emergency department (ED) based on current evidence. Discussion: SEA is a suppurative infection and infectious disease emergency that may result in significant morbidity and even mortality. It is a challenging diagnosis due to its range of risk factors and variety of presentations with up to 90% of patients misdiagnosed on their first ED visit. Factors associated with increased risk of SEA include immunocompromise, bacteremia, contiguous infection (e.g., psoas muscle abscess, osteomyelitis, skin infection), and spinal instrumentation. However, the absence of risk factors cannot be used to exclude SEA. The classic triad of back pain, fever, and neurologic deficit occurs in less than 8% of cases, though back pain is a common presenting symptom. Up to half of patients experience a neurologic abnormality, but fever is absent in 50%. Laboratory assessment may assist with inflammatory markers elevated in the majority of cases. Diagnosis includes magnetic resonance imaging with and without contrast and blood cultures, and management includes spinal specialist consultation and antibiotic therapy. Conclusions: An understanding of SEA can assist emergency clinicians in diagnosing and managing this potentially deadly disease.",
keywords = "Infectious disease, Orthopedics, Spinal epidural abscess, Spine",
author = "Brit Long and Jestin Carlson and Tim Montrief and Alex Koyfman",
note = "Funding Information: BL, AK, JC, and TM conceived the idea for this manuscript and contributed substantially to the writing and editing of the review. This manuscript did not utilize any grants, and it has not been presented in abstract form. This clinical review has not been published, it is not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. This review does not reflect the views or opinions of the U.S. government, Department of Defense, U.S. Army, U.S. Air Force, or SAUSHEC EM Residency Program. Publisher Copyright: {\textcopyright} 2022",
doi = "10.1016/j.ajem.2022.01.008",
journal = "American Journal of Emergency Medicine",
T1 - High risk and low prevalence diseases
T2 - Spinal epidural abscess
AU - Long, Brit
AU - Carlson, Jestin
AU - Montrief, Tim
AU - Koyfman, Alex
N1 - Funding Information: BL, AK, JC, and TM conceived the idea for this manuscript and contributed substantially to the writing and editing of the review. This manuscript did not utilize any grants, and it has not been presented in abstract form. This clinical review has not been published, it is not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. This review does not reflect the views or opinions of the U.S. government, Department of Defense, U.S. Army, U.S. Air Force, or SAUSHEC EM Residency Program. Publisher Copyright: © 2022
N2 - Introduction: Spinal epidural abscess (SEA) is a rare but serious condition that carries with it a high rate of morbidity and mortality. Objective: This review highlights the pearls and pitfalls of SEA, including presentation, initial evaluation, and management in the emergency department (ED) based on current evidence. Discussion: SEA is a suppurative infection and infectious disease emergency that may result in significant morbidity and even mortality. It is a challenging diagnosis due to its range of risk factors and variety of presentations with up to 90% of patients misdiagnosed on their first ED visit. Factors associated with increased risk of SEA include immunocompromise, bacteremia, contiguous infection (e.g., psoas muscle abscess, osteomyelitis, skin infection), and spinal instrumentation. However, the absence of risk factors cannot be used to exclude SEA. The classic triad of back pain, fever, and neurologic deficit occurs in less than 8% of cases, though back pain is a common presenting symptom. Up to half of patients experience a neurologic abnormality, but fever is absent in 50%. Laboratory assessment may assist with inflammatory markers elevated in the majority of cases. Diagnosis includes magnetic resonance imaging with and without contrast and blood cultures, and management includes spinal specialist consultation and antibiotic therapy. Conclusions: An understanding of SEA can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
AB - Introduction: Spinal epidural abscess (SEA) is a rare but serious condition that carries with it a high rate of morbidity and mortality. Objective: This review highlights the pearls and pitfalls of SEA, including presentation, initial evaluation, and management in the emergency department (ED) based on current evidence. Discussion: SEA is a suppurative infection and infectious disease emergency that may result in significant morbidity and even mortality. It is a challenging diagnosis due to its range of risk factors and variety of presentations with up to 90% of patients misdiagnosed on their first ED visit. Factors associated with increased risk of SEA include immunocompromise, bacteremia, contiguous infection (e.g., psoas muscle abscess, osteomyelitis, skin infection), and spinal instrumentation. However, the absence of risk factors cannot be used to exclude SEA. The classic triad of back pain, fever, and neurologic deficit occurs in less than 8% of cases, though back pain is a common presenting symptom. Up to half of patients experience a neurologic abnormality, but fever is absent in 50%. Laboratory assessment may assist with inflammatory markers elevated in the majority of cases. Diagnosis includes magnetic resonance imaging with and without contrast and blood cultures, and management includes spinal specialist consultation and antibiotic therapy. Conclusions: An understanding of SEA can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
KW - Infectious disease
KW - Orthopedics
KW - Spinal epidural abscess
KW - Spine
U2 - 10.1016/j.ajem.2022.01.008
DO - 10.1016/j.ajem.2022.01.008
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine