The Prognostic Accuracy of Suggested Predictors of Failure of Medical Management in Patients With Nontuberculous Spinal Epidural Abscess

Global Spine J. 2018 May;8(3):279-285. doi: 10.1177/2192568217719437. Epub 2017 Jul 20.


Study design: Retrospective cohort study.

Objectives: To test the external validity of the 2 published prediction criteria for failure of medical management in patients with spinal epidural abscess (SEA).

Methods: Patients with SEA over a 10-year period at a tertiary care center were identified using ICD-10 (International Classification of Diseases, 10th Revision) diagnostic codes; electronic and paper charts were reviewed. The incidence of SEA and the proportion of patients with SEA that were treated medically were calculated. The rate of failure of medical management was determined. The published prediction models were applied to our data to determine how predictive they were of failure in our cohort.

Results: A total of 550 patients were identified using ICD-10 codes, 160 of whom had a magnetic resonance imaging-confirmed diagnosis of SEA. The incidence of SEA was 16 patients per year. Seventy-five patients were found to be intentionally managed medically and were included in the analysis. Thirteen of these 75 patients failed medical management (17%). Based on the published prediction criteria, 26% (Kim et al) and 45% (Patel et al) of our patients were expected to fail.

Conclusions: Published prediction models for failure of medical management of SEA were not valid in our cohort. However, once calibrated to our cohort, Patel's model consisting of positive blood culture, presence of diabetes, white blood cells >12.5, and C-reactive protein >115 was the better model for our data.

Keywords: epidural; infection; neurology.