Paper Title
SPINAL MAGNETIC RESONANCE IMAGING (MRI) IN PATIENTS WITH SUSPECTED METASTATIC SPINAL CORD COMPRESSION (MSCC): A QUALITY IMPROVEMENT PROJECT

Abstract
Metastatic spinal cord compression (MSCC) is a frequent complication in cancer patients, occurring in 3-5% of diagnosed cases annually, and serves as the initial manifestation of malignancy in 20% of patients.1-2 The timely diagnosis and management of MSCC are critical due to the risks of irreversible neurological damage and significant impacts on both quality and quantity of life. The National Institute for Health and Care Excellence (NICE) recommends that patients presenting with back pain alongside neurological signs and/or symptoms undergo whole spine Magnetic Resonance Imaging (MRI) within 24 hours.3 This retrospective study at Medway Maritime Hospital, England, The United Kingdom, aimed to assess the adherence to these guidelines by reviewing the time from presentation to MRI for patients with MSCC symptoms and/or signs. This retrospective study at Medway Maritime Hospital, England, The United Kingdom, aimed to assess the adherence to these guidelines by reviewing the time from presentation to MRI for patients with MSCC symptoms and/or signs. Data was collected retrospectively using patient electronic records and the acute oncology services database for two complete cycles, each of which extending over a period of one year. Cycle one included 69 patients whereas cycle two included 113.The data analysis of the first cycle revealed that MRI was conducted within 24 hours in only 43 out of 69 cases (62%), and that 16 out of 25 cases (25 being the total delayed cases) were delayed by more than 48 hours. To improve guideline adherence, interventions such informational flyers and regular MSCC training sessions in the form of trainee teaching as well as presentations in grand rounds were implemented. The follow-up re-audit demonstrated an improvement in adherence to the 24-hour MRI spine guidelines with 81 out of 113 cases (71%) meeting the target. The second cycle also included the reasons for delays when documented and identified patient compliance and pain control as the primary causes. Additionally, the timing of steroid administration following MSCC suspicion was recorded.Future studies will re-evaluate adherence, aim to improve the documentation of delay causes, enhance pain management prior to MRI scans, and ensure the prompt administration of steroids.