ORIGINAL ARTICLE   

Journal of Neurosurgical Sciences 2024 Dec 17

DOI: 10.23736/S0390-5616.24.06300-8

Copyright © 2024 EDIZIONI MINERVA MEDICA

lingua: Inglese

Suspected and surgically managed cauda equina syndrome nationwide: epidemiological trends and socioeconomic factors influencing access to care

Thomas M. JOHNSTONE ¹ ✉, Vaibhavi SHAH ¹, Ghani HAIDER ², Kelly H. YOO ², Martin N. STIENEN ³, Anand VEERAVAGU ²

¹ Stanford University School of Medicine, Stanford, CA, USA; ² Department of Neurosurgery, School of Medicine, Stanford University, Stanford, CA, USA; ³ Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital St. Gallen, Switzerland

BACKGROUND: Cauda equina syndrome (CES) is a critical condition requiring timely intervention to prevent severe morbidity. This study investigates the epidemiology and socioeconomic factors influencing access to CES care in USA Emergency Departments.
METHODS: Data was used from the Nationwide Emergency Department Sample (NEDS) from 2016-2020. Encounters for patients presenting with suspected CES were queried using ICD 10 codes. Incidence estimates for suspected and surgically managed CES were constructed. Encounter characteristics were tabulated to describe aspects of a typical CES presentation to a USA ED. Multivariable regression analysis ascertained the impact of hospital and socioeconomic features on in-hospital mortality, surgical management, length of stay, visit costs, and patient transfer.
RESULTS: The incidences of suspected and surgically managed CES rose year-by-year (P=0.006; P=0.005). Uninsured patients (P<0.001) and African American (P=0.002) were less likely to be admitted for care. Patients residing in the wealthiest quartile of zip codes were more likely to be admitted for care (P<0.001). In addition, uninsured (P=0.017) and African American patients (P=0.009) were less likely to receive surgical management of suspected CES. Lastly, uninsured (P<0.001), Hispanic (P=0.038), and rurally located patients (P=0.007) were more likely to be transferred, while patients residing in the wealthiest zip codes (P=0.007) were less likely to be transferred.
CONCLUSIONS: Socioeconomic factors like race, income, insurance, and residence potentially alter CES management, which may inform health policy and future patient care.

KEY WORDS: Cauda equina syndrome; Hospital emergency service; Healthcare outcome assessment