{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:18:33Z","timestamp":1788412713965,"version":"build-2803163510"},"reference-count":23,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Neuroradiol J"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Cauda equina syndrome (CES) is a rare but serious neurosurgical emergency. Back pain and sciatica are common presentations to A&amp;E. Get It Right First Time (GIRFT) published guidance in February 2023 regarding the red flag symptoms and symptom duration requiring emergency MRI. This framework has been utilised by the orthopaedic service within our hospital. The aim of this study was to assess whether implementing GIRFT guidance could reduce CES related admissions without impacting the diagnostic yield for identifying this emergency.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Retrospective review of all emergency MRI scans to exclude CES during two 6-month periods. GIRFT guidance was published in February 2023. Period 1 (01\/08\/2022\u201331\/01\/2023) was prior to GIRFT guidance and period 2 (01\/08\/2024-31\/01\/2025) was more than 1\u00a0year after GIRFT guidance. Statistical analysis was undertaken using Chisquared and Mann\u2013Whitney testing.\n                    <jats:bold>Results:<\/jats:bold>\n                    There were 175 emergency MRI scans to exclude CES during period 1 versus 159 during period 2. After implementation of GIRFT guidance, there was a significant reduction in the percentage of patients requiring admission (42.77% vs 56.57%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.016) and an increase in the percentage of patients scanned on the day of presentation (61.64% vs 52.57%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.119). There was no change in the diagnostic yield of scans for identifying CES (4.57% vs 4.4%,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 1).\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Our results show that utilisation of the GIRFT guidance reduced CES related admissions without negatively impacting diagnostic yield. These findings highlight the value of implementing GIRFT guidelines in neurosurgical and orthopaedic departments across the country.\n                  <\/jats:p>","DOI":"10.1177\/19714009251385226","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T18:03:27Z","timestamp":1759946607000},"page":"353-359","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["GIRFT guidance reduces cauda equina syndrome (CES) related admissions without negatively impacting diagnosis"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9911-5141","authenticated-orcid":false,"given":"Sai Viswan","family":"Thiagarajah","sequence":"first","affiliation":[{"name":"Northern Care Alliance NHS Foundation Trust Oldham Care Organisation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Cornish","sequence":"additional","affiliation":[{"name":"Trauma and orthopaedics, Stockport NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Northern Care Alliance NHS Foundation Trust Oldham Care Organisation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Telford","sequence":"additional","affiliation":[{"name":"Northern Care Alliance NHS Foundation Trust Oldham Care Organisation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Langstroth","sequence":"additional","affiliation":[{"name":"Northern Care Alliance NHS Foundation Trust Oldham Care Organisation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Koo","sequence":"additional","affiliation":[{"name":"Northern Care Alliance NHS Foundation Trust Oldham Care Organisation"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"StatPearls [Internet]. Treasure Island (FL)","author":"Harrow-Mortelliti M","year":"2023","unstructured":"Harrow-Mortelliti M, Reddy V, Jimsheleishvili G. Physiology, spinal cord. StatPearls [Internet]. Treasure Island (FL). StatPearls Publishing, 2023."},{"key":"e_1_3_4_3_2","volume-title":"StatPearls [Internet]. Treasure Island (FL)","author":"Rider LS","year":"2025","unstructured":"Rider LS, Marra EM. Cauda Equina and Conus Medullaris syndromes. 2023 Aug 7. StatPearls [Internet]. Treasure Island (FL). StatPearls Publishing, 2025."},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-010-1668-3"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200808000-00006"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.12968\/hmed.2023.0012"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2020.05.260"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2012.02.012"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199402001-00020"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200006150-00010"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198668030-00011"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/20494637221119924"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2019.05.004"},{"key":"e_1_3_4_14_2","unstructured":"GIRFT (Getting it Right First Time). Spinal surgery: national suspected Cauda Equina syndrome (CES) pathway. https:\/\/www.spinal.co.uk\/wp-content\/uploads\/2023\/08\/National-Suspected-Cauda-Equina-Pathway-February-2023-FINAL-V1-1.pdf (2023) Accessed 05 05 2025."},{"key":"e_1_3_4_15_2","unstructured":"BoltBurdonKemp. Cauda Equina syndrome \u2013 how successful has the implementation of the GIRFT pathway been? 2025. [Accessed 05\/05\/2025]:https:\/\/www.boltburdonkemp.co.uk\/our-insights\/campaigns\/cauda-equina-syndrome-how-successful-has-the-implementation-of-the-girft-pathway-been\/#:\u223c:text=Cauda_Equina_Syndrome_requires_immediate for_patients_presenting_with_CES"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-033367"},{"key":"e_1_3_4_17_2","unstructured":"NHS choices. Available at: https:\/\/www.england.nhs.uk\/statistics\/statistical-work-areas\/bed-availability-and-occupancy\/bed-data-overnight\/ (Accessed: 31 May 2025)."},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/1971400915598074"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1159\/000527727"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20696"},{"issue":"2586","key":"e_1_3_4_21_2","article-title":"Gender-related epidemiological characteristics of cauda equina syndrome caused by disc herniation: a 10-year study in Zenica-Doboj Canton","author":"Sefo H","year":"2024","unstructured":"Sefo H. Gender-related epidemiological characteristics of cauda equina syndrome caused by disc herniation: a 10-year study in Zenica-Doboj Canton. 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