DOI: 10.1093/bjs/znad258.445 ISSN:

1249 A Single Centre Analysis of Cauda Equina Referrals Since the ENTICE National Audit

H Choudhry, A Vasilla, O Richards, M Schramm, N Kalra, A Sheikh
  • Surgery



To analyse changes in the referral patterns of Cauda Equina Syndrome (CES) following the publication of the national ENTICE study.


A retrospective analysis was conducted of all 933 patients referred to Leeds Neurosurgery department in a 6- month period (1st October 2019- 1st February 2020) for suspected CES. The referrals were analysed to assess compliance with the updated national BASS/ SBNS guidelines, primarily to determine if an MRI had been performed prior to referral. This was compared with data prior to the national ENTICE study.


933 patients were referred to Leeds Neurosurgery department for suspected CES in the 6-month period. This is a 31% increase prior to the ENTICE study. Of these referrals, 65 had radiologically confirmed CES. 15% of those referred had an MRI prior to referral. 15.5% of referrals in hours had an accompanying scan compared with 14.5% of referrals out of hours. 8% of referrals from centres with access to out of hours scanning did not have an MRI prior to referral.


Referrals should only be sent after CES has been radiologically confirmed, according to national guidelines. Despite changes in the referral system, the number and quality of referrals has not improved since the ENTICE national audit. A lack of out of hours MRI provision has little effect on referrals without a scan. Only 7% of CES referrals had confirmed CES, thus it is imperative that guidelines are followed to reduce delays in neurosurgical care.

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