Pediatric Spinal Epidural Abscess: Recognition and Management in the Emergency Department -
Publication Date: June 2022 (Volume 19, Number 6)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 06/01/2025.
Bahareh Ravandi, MD
Clinical Assistant Professor of Pediatrics, Keck School of Medicine, University of Southern California, Children’s Hospital Los Angeles, Los Angeles, CA
Christine S. Cho, MD, MPH, MEd
Fellowship and Education Director, Children’s Hospital of Los Angeles; Associate Professor of Clinical Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
Winnie Whitaker, MD
Associate Professor, Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX; Interim Medical Director, Emergency Department, Dell Children's Medical Center of Central Texas, US Acute Care Solutions, Austin, TX
Amy Z. Zhou, MD, PhD
Assistant Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
Although rare in children, spinal epidural abscess (SEA) is a rapidly progressive clinical entity that can lead to irreversible neurologic damage if untreated. The rarity and variability in presentation can lead to initial misdiagnosis. Diagnosis requires a high index of suspicion and is often delayed until neurologic deficits are present. This issue reviews key findings on the history and physical examination that are associated with SEA, provides guidance for the laboratory tests and imaging studies that are indicated once SEA is suspected, and discusses treatment options based on current evidence.
A 30-month-old girl presents by referral from her primary care physician for fever and refusal to walk…
The parents tell you there is no history of trauma.
You note the girl is febrile, tachycardic, and crying. Upon examination, her right hip and knee are in flexion, and she cries when you attempt to extend her knee. You cannot identify an area of focal tenderness to palpation. When the patient is prompted to bear weight on her right lower extremity, she touches her toes to the floor but refuses to bear weight.
What is the differential diagnosis? What laboratory and radiographic studies would be helpful in making the diagnosis?
A 10-year-old boy is referred from a regional hospital for 5 days of fever and lumbar area pain...
The boy is uncomfortable due to the pain, but he can walk.
Upon examination, you discover midline spinal tenderness at the L2 level and edema of paraspinal muscles. You do not find any neurologic deficits on examination.
What diagnostic studies and therapies should be initiated?
A 13-year-old girl presents with diffuse abdominal pain and fever...
You admit her with the assumption that she has appendicitis. A few days later you receive an email from the quality division of your hospital to inform you that the patient’s ultimate diagnosis was spinal epidural abscess.
You reflect on how you could have missed this diagnosis. What could you have done differently?
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