Browsing by Author "Stratton, Alexandra"

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    The Prognostic Accuracy of Suggested Predictors of Failure of Medical Management for Patients with Spinal Epidural Abscess
    (2016) Stratton, Alexandra; Thomas, Kenneth; Dixon, Elijah; Faris, Peter; Tomkins-Lane, Christy
    Controversy exists as to the first-line treatment in patients with spinal epidural abscess (SEA) who present with an intact neurologic exam—medical treatment or surgery. The aim of this thesis was to clarify treatment decision making in such patients. A systematic review and meta-analysis were first undertaken to define the risk of failure of medical treatment and to identify predictors of failure. Although the incidence of failure of medical management of SEA was found to be relatively common in published reports, estimates were highly heterogeneous between studies. Two studies were identified in the literature with prediction criteria for failure of medical management. These prediction criteria were tested in a cohort of patients from a tertiary care centre and both overestimated medical treatment failure. Once the prediction models were calibrated to our data it was Patel’s model that was superior and thus more useful for clinical decision making.