Emergency Medicine Expert Discusses Delayed Diagnosis of Spinal Abscess

This case involves a male patient in Georgia who presented to the emergency department by EHS with complaints of neck pain for several days. He was evaluated by a nurse practitioner and was promptly discharged with a diagnosis of muscle strain. He was not examined by a physician and no imaging studies including an CT scan were conducted. Several days later the patient returned to the emergency room (ER) with reports of ongoing neck pain, as well as the onset of numbness in his right thigh. He underwent a series of imaging studies and test which were largely normal, except for a slightly elevated white blood cell count. He was diagnosed with an upper respiratory infection, prescribed antibiotics, and sent home. The next day, the patient again returned to the emergency room with severe weakness in his lower extremities. It was eventually discovered that the patient was suffering from a previously undiagnosed spinal abscess. The patient was rendered paraplegic despite treatment.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in the case?

2. Have you ever had a patient develop the outcome described in the case?

3. Given her symptoms, should the patient not have been discharged on his second visit?

Expert Witness Response E-008258

I have treated many patients with spinal cord epidural abscesses, and I have seen patients who have become paraplegic due to spinal cord epidural abscesses. The second visit is concerning and needs further evaluation. With a high white count, tenderness over the spine, and bilateral numbness in the thighs, it seems that the workup was inadequate. Also, what was the MD looking for on the CT? If it was a spinal abscess, then MRI is the gold standard test. I have been a board certified emergency physician for 10 years, I am a grant funded researcher in the field of emergency medicine and quality improvement, I work at a top academic institution, and I am an examiner of the American Board of Emergency Medicine.