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Epidural abscess
Likely the most serious missed emergent condition in patients diagnosed with non-specific back pain.
Challenging diagnosis to make in the ED
Almost half of patients are initially misdiagnosed and average two ED visits before the diagnosis is made.
- Insidious presentation with non-specific symptoms such as fatigue and nausea.
- Symptoms may initially improve with conservative measures such as rest, often leading to an initial non-infectious diagnosis such as musculoskeletal back pain.
At the time of diagnosis, the most common symptom is diffuse spine pain and the most common exam finding is severe local spinal tenderness.
Fever is only present in 30% to 50% of patients at presentation.
In one study, over 65% of patients with spinal epidural abscesses were afebrile on presentation.
Also, consider that the neurological examination is normal in two-thirds of patients at their first ED visit.