Spinal Epidural Abscess in a Medical Center in Taiwan: Its Implications on the Education of Medical Care Providers, Treatment Choice, and Health System Reform

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Objective:To see whether the characteristics of spinal epidural abscess (SEA) patients change after the National Health Insurance program of Taiwan was implemented in 1995.Methods:We followed the 13 SEA patients who had been admitted to a medical center (Wan-Fang Hospital Taipei Medical University) in northern Taiwan between 1997 and 2010. Their medical data were reviewed and summarized. The summary was then compared with those of previously published data.Results:The average age, duration of symptoms before admission, hypoesthesia rate, and urinary/fecal incontinence rate of our patients were 69.5 years old, 21.2 days, 76.9%, and 53.9%, respectively. Percussion tenderness on admission (46.2%) was barely sought before and could have clinical value. The most common predisposing factor in our study was diabetes mellitus (46.2%). There was no alcoholism, intravenous drug use, and spinal trauma in our patients. Elevated erythrocyte sedimentation rate was 100% positive in our patients if the examination was ordered for them. Lumbosacral vertebrae (50.0%) and Staphylococcus aureus (30.0%) were the most involved spine segment and the identified pathogen, respectively. More than two thirds (69.2%) of our patients received surgical treatment. On discharge, 53.8% of our patients presented irreversible plegia.Conclusions:Compared with the previous reports, we found some unique features in our patient group and concluded that health caregivers must keep in mind SEA and its risk factors and act promptly. Unnecessary operations and antibiotics use should be watched, and the National Health Insurance should exercise a reform to reduce financial deficits, skewed health care-seeking behavior, and unnecessary treatments.

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