1. ¹Department of Palliative Medicine, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
2. ²Department of Statistics, University of Dundee, Dundee DD1 4HN, Scotland, UK
3. ³Department of Oncology, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
4. ⁴Department of Neurosurgery, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
5. ⁵St Brycedale Surgery, St Brycedale Road, Kirkcaldy, Scotland, UK
6. ⁶Department of Radiology, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
7. ⁷Department of Radiation Oncology, University of Dundee, Dundee DD1 9SY, Scotland, UK

Correspondence: Dr P Levack, E-mail: pamela.levack@nhs.net

Received 18 December 2008; Revised 1 April 2009; Accepted 8 April 2009; Published online 26 May 2009.

Abstract

The aim of the study was to achieve earlier diagnosis of malignant cord compression (MCC) using urgent magnetic resonance imaging (MRI) for selected patients. A comparison was carried out of the current prospective audit of 100 patients referred by a general practitioner or a consultant over 32 months with both a previous national Clinical Research and Audit Group (CRAG) prospective audit (324 cases of MCC) and an earlier retrospective audit of 104 patients referred with suspected MCC. A telephone hotline rapid-referral process for patients with known malignancy and new symptoms (severe nerve root pain severe back pain) was designed. Patients were considered for urgent MRI after discussion with a senior clinician responsible for the hotline. Appropriate referrals were discussed with radiology and oncology ensuring timely MRI reporting and intervention. The main outcome measures are as follows: time from referral to diagnosis; time from the onset of symptoms to diagnosis; and mobility at diagnosis. A total of 50 patients (52%) of those scanned had either MCC (44) or malignant nerve root compression (6) compared with the earlier rate of 23 out of 104 patients (22%). Ten out of 44 MCC patients (23%) were paralysed at diagnosis, compared with 149 out of 324 (46%) in the CRAG audit. Time from reporting pain to diagnosis was 32 days compared with 89 days in the CRAG audit. Median time from referral to diagnosis was 1 day, again considerably shorter than the CRAG audit time of 15 days (interquartile (IQ) range: 3–66). In patients at risk of MCC, fast-track referral with rapid access to MRI reduces time between symptom onset and diagnosis, improves mobility at diagnosis and reduces the number of negative MRI scans.