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Ohio University Heritage College of Osteopathic Medicine
Originally Published: Modern Resident April/May 2015
As an emergency medicine physician it is important to always think about the worst-case scenario. What is the worst thing that could explain this patient’s symptoms? What could potentially kill this patient if not quickly identified and appropriately managed? For common complaints such as back pain, this mindset can easily be over looked. No matter how simple and straightforward a case of back pain may seem, it is still important to ensure there are no red flags. One of the most concerning worst-case scenarios of low back pain is that of a spinal epidural abscess.
Recent studies have shown that the number of cases of spinal epidural abscesses is rising due to an increase in IV drug abuse and spinal surgeries.[2,3] If overlooked, this infection can cause a rapid decline and lead to sepsis, meningitis and permanent paralysis.[3] With a mortality rate as high as 20%, it is vital to catch this infection on the patient’s first presentation.[2,3] Diagnostic delays are far too common in these patients. In 2003, a retrospective study looked at 63 cases of spinal epidural abscesses. It was found that 75% of these cases had multiple ED visits or were admitted without a clear diagnosis.[1]
