Spinal Epidural Abscess Decision Guideline
Selects which patients with spine pain need imaging for a spinal epidural abscess.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Injection drug use
- Yes
- Sedimentation rate
- 45 mm per hour
- White cell count
- 8 thousand per microliter
Result: image, at 45 mm per hour
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Any neurologic deficit
- Image now, whatever the risk factors and whatever the sedimentation rate.
- A risk factor, no deficit
- Check a sedimentation rate. Over 20 mm per hour, image.
- No risk factor, no deficit
- Not selected for imaging on this pathway. That is not the same as excluding the diagnosis.
- The five risk factors
- Injection drug use, an indwelling vascular access device, a site of infection elsewhere, immunosuppression, and a spinal procedure within the past year. Any one opens the pathway.
- The classic triad
- Fever, spine pain and a neurologic deficit together appear in only a small minority of confirmed cases. Waiting for it is the delay.
- Fever
- Absent in about half of confirmed cases, and not an entry criterion here. Its absence removes nothing.
- The white cell count
- Normal in a large share of confirmed cases. The sedimentation rate is the test this pathway uses.
What you enter
- Any neurologic deficit
- Injection drug use
- An indwelling vascular access device
- A site of infection elsewhere in the body
- Immunosuppression, including diabetes, HIV, cancer, dialysis, and alcohol use disorder
- A spinal procedure or spinal surgery within the past year
- Fever
- Sedimentation rate
- White cell count
How this is calculated
Davis DP, Salazar A, Chan TC, Vilke GM. 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. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.