The classic triad of a spinal epidural abscess:
(1) fever (temperature >= 38°C or >= 100.4°F)
(2) spine pain
(3) neurologic deficit
Criteria for diagnostic delay - one of the following:
(1) multiple visits to the ED before diagnosis
(2) admission without the diagnosis of spinal epidural abscess AND > 24 hours before a definitive study
The classic triad was seen in only 13% of patients with SEA and 1% of controls. 98% of SEA patients and 21% of controls had one or more of the triad factors.
Risk factors associated with SEA:
(1) intravenous drug use
(2) immunocompromised
(3) alcohol abuse
(4) recent spinal surgery or trauma
(5) diabetes mellitus
(6) distant site of infection
(7) indwelling catheter
(8) cancer
An erythrocyte sedimentation rate (ESR) > 20 mm in the first hour was seen in 98% of patients.
A WBC count > 10,000 per µL was seen in 60%.
Recommendations:
(1) Do not completely rely on the classic triad, especially the neurologic deficit.
(2) Have a high index of suspicion in patients with one or more risk factors.
(3) An elevated inflammatory marker (ESR) is a clue for a patient with spine pain.
where:
• C-reactive protein could be added as an inflammatory marker.
