Tags
Ped. Emerg. Med. Practice
Published
June 2, 2022
Author(s)
Bahareh Ravandi, MD;
Christine S. Cho, MD, MPH, MEd
Decision
- Patient presents with fever and back pain
- Obtain thorough history and physical examination - see Background section (Class I)
- If spinal epidural abscess (SEA) is on the differential, proceed to the question below:
Does the patient have neurological deficits?
Background
Signs and Symptoms of Spinal Epidural Abscess, by Stage
Stage | Signs and Symptoms |
1 | Fever, back pain, and tenderness |
2 | Change in reflexes, signs of meningeal or radicular irritation |
3 | Motor and sensory deficits, bowel, and/or bladder dysfunction |
4 | Paralysis |
Once a patient has neurologic deficits consistent with stage 3, progression to paralysis (stage 4) within 24 hours is likely. Prognosis after 24 to 36 hours of paralysis is poor
Obtaining a thorough history and physical examination:
- Classic triad of fever, spinal pain, and neurological symptoms is seen in only 8% of cases
- The most common signs symptoms are fever alone (66%-75%) and back pain alone (71%)
- Fever and irritability or fussiness may be the only symptoms noted in neonates and infants
- Younger children may present with lower extremity or hip pain manifesting as refusal to bear weight
- Headache and neck stiffness may be present, which add meningitis and neck infections (eg, retropharyngeal abscess) to the differential diagnosis
- Bowel and bladder dysfunction may be present, but these are signs of stage 3 disease and may not be present early in the course
- In younger or developmentally delayed pediatric patients, signs such as urinary incontinence would be difficult to note
- History should also include questions about recent skin and soft-tissue infections, febrile illnesses, and procedures, as they may have served as a source of hematogenous spread
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Full Spinal Epidural Abscess Pathway
SEA with Neurological Deficits
SEA Suspected without Neurological Deficits