Paucis Verbis: Spinal epidural abscess

One of the most challenging diagnoses to make is that of a spinal epidural abscess (SEA), especially if you work in an Emergency Department which cares for many IV drug users and HIV patients. There’s never before been a published diagnostic guideline or algorithm which helps you with risk-stratification.

In the Journal of Neurosurgical Spine, a diagnostic guideline was prospectively evaluated on a small population (n=31) as compared to historical controls (n=55). They found that an ESR test had a sensitivity of 100% if a patient had at least 1 risk factor for SEA. A CRP test was much less helpful.

Not a practical algorithm

Unfortunately, they didn’t study the utilization rate of the MRI scanner with this guideline. Are they getting better results (fewer diagnostic delays and fewer cases of patients later in their clinical course) because they are just MRI-scanning more people? Almost everyone in my ED with back pain would fall into the Urgent/Emergent MRI box… I’m not a fan of this algorithm.

Regardless, this algorithm may help you in shaping your diagnostic decision and medical decision making documentation.

PV Card: Spinal Epidural Abscess

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Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

Davis D, Salazar A, Chan T, Vilke G. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine. 2011;14(6):765-770. [PubMed]

By Michelle Lin, MD|2021-10-12T16:17:13-07:00Aug 5, 2011|ALiEM Cards, Infectious Disease, Neurology|

Faculty hero: Dr. Jim Adams (part 2)

Continuing from the Part 1 (Aug 2, 2011 post), here is the rest of my conversation with Dr. Jim Adams:

What cool things are you working on right now?

The big projects that I am working on include:

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By Michelle Lin, MD|2016-11-11T18:52:29-08:00Aug 4, 2011|Medical Education|

Trick of the Trade: Balloon animals in the ED

Back in July 2010, I wrote about using the Candleflame app to encourage pediatric patients to take deep breaths for a pulmonary exam. This app has also been useful in helping me roughly gauge the patient’s peak flow.

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By Michelle Lin, MD|2026-06-16T16:03:04-07:00Aug 3, 2011|Pediatrics, Tricks of the Trade|

Faculty hero: Dr. Jim Adams (part 1)

There are many leaders in Emergency Medicine but there are few who are true visionaries. Dr. Jim Adams (Chair at Northwestern’s Department of EM) is one such visionary. He’s given numerous lectures, providing sage advice to faculty, residents, and students. I’ve always thought it a shame these aren’t more available to people. So I contacted Jim to learn more about him, his career path, and advice for young emergency physicians.

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By Michelle Lin, MD|2016-11-11T18:52:29-08:00Aug 2, 2011|Medical Education|

Article Review: Performing a database search

At the end of each Academic Medicine journal issue, there is a great “last page” one-page teaching point in medical education research. There’s no earth-shattering news, but they are great reviews of key elements in education research.

The most recent issue reviews the process of performing an effective database search in medical education research. It was authored by my friend Lauren, who is a medical education librarian at Stanford and a co-author with me on an annual series “Critical Appraisal in Emergency Medicine Education Research”.

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By Michelle Lin, MD|2018-01-30T02:24:16-08:00Aug 1, 2011|Education Articles, Medical Education|

New guest blogger: Dr. Hans Rosenberg

Let’s make it official. Dr. Hans Rosenberg has been contributing great content for this site. We’re honored to have him officially join our blogging team!

Dr. Rosenberg did his residency at the University of Ottawa, graduating in 2009. He now works at the Ottawa Hospital Emergency Department as a Consultant Staff Physician and is an Assistant Professor at the University of Ottawa. His interests in medical education are specifically related to our interaction with technology and how we use it to learn, educate and improve our practice of Emergency Medicine.

By Michelle Lin, MD|2019-09-10T14:04:22-07:00Jul 29, 2011|Life|

Inspirational graduation speech by Conan

“Your perceived failure can become a catalyst for profound reinvention.”

“No specific job or career goal defines me, and it should not define you.”

— Conan O’Brien

I found this inspirational 2011 graduation speech by Conan O’Brien at Dartmouth College. It is a great mix of silly, witty, inspirational, and profound. Check it out. For those in Medicine and medical training, your dreams may change over time… and that’s ok.

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By Michelle Lin, MD|2019-01-28T22:36:32-08:00Jul 28, 2011|Medical Education|

About Michelle Lin, MD

Not a practical algorithm

PV Card: Spinal Epidural Abscess

Reference

What cool things are you working on right now?