Below is an article that I wrote regarding spinal epidural abscess (SEA).  Please click the link for the full article.  The article discusses the role of the emergency medicine physician expert witness and why they are qualified to determine if the standard of care was met in patients with the dangerous and rare condition of spinal epidural abscess.

Spinal epidural abscess (SEA) is a rare diagnosis that has recently received more attention in emergency department training. The American Board of Emergency Medicine (ABEM) has heightened the awareness amongst its physicians in their latest recertification testing. Spinal epidural abscess is a disease in which there is an infection within the skull or spinal column that can have severe morbid consequences such as severe weakness or even paralysis.  

Due to the potentially severe consequences and lifelong expenses of caring for someone with a spinal epidural abscess, medical malpractice plaintiff attorneys often seek large payouts when it goes undetected. The malpractice attorneys will use a spinal epidural abscess expert witness to testify about the medical consequences of delayed or missed diagnosis.

There seems to be an increasing prevalence in the diagnosis of SEA.  This could be due to a multitude of factors such as more availability of MRIs or an increased prevalence, and awareness, of the disease. 

The emergency doctor is the one often tasked with diagnosing this rare condition and is therefore considered a medical expert in the diagnosis of an epidural abscess. However, for an emergency physician, since back pain is an incredibly common presenting symptom in the ER, diagnosing SEA is like looking for the proverbial needle in the haystack. Because the diagnosis of spinal epidural abscess represents a tiny fraction of all patients with back pain, the emergency physician must always maintain a high index of suspicion.

Therefore, the training of emergency medicine physicians requires that they are always on the lookout for “red flags” signs such as fever, immunocompromising medications or conditions, diabetes, prior spinal procedures or surgeries, or prior intravenous drug use. The emergency medicine expert witness can help determine if the standard of care was met in the assessment of the patient with spinal epidural abscess.

The challenge for the emergency physician is trying to distinguish which patients need the emergent MRI. Based on the frequency of back pain complaints in the emergency department, the emergency physician must have discretion on when to order this crucial test.  Other supplemental tests that can aid in the diagnosis are blood tests such as the CBC (complete blood count) with differential, the ESR (erythrocyte sediment rate), and the CRP (C-reactive protein). If there is a strong index of suspicion when initially seeing the patient, the emergency medicine physician should call the neurosurgeon and start intravenous antibiotics STAT. The emergency medicine expert witness can help determine if the appropriate tests were ordered and interventions were done in a timely manner.  

In summary, spinal epidural abscess can have dire consequences and early detection will significantly improve the patient’s prognosis and outcome.  The emergency medicine physician expert witness will be able to help determine if the standard of care was met as expediently as possible.

READ MORE ABOUT IT HERE → Full Article: Spinal Epidural Abcess Expert

Paul Louis, M.D., FAAEM

Dr. Louis can be reached at or 561-445-6674.