High risk clinical characteristics for pyogenic spinal infection in acute neck or back pain: Prospective cohort study

Abstract Objective To identify clinical characteristics associated with pyogenic spinal infection among adults presenting to a community emergency department (ED) with neck or back pain. A secondary objective was to describe the frequency of these characteristics among patients with spinal epidural abscess (SEA). Methods We conducted a prospective cohort study in a community ED enrolling adults with neck or back pain in whom the ED provider had clinical concern for pyogenic spinal infection. Study phase 1 (Jan 2004–Mar 2010) included patients with and without pyogenic spinal infection. Phase 2 (Apr 2010–Aug 2018) included only patients with pyogenic spinal infection. We performed univariate and multivariate analyses for association of clinical characteristics with pyogenic spinal infection. Results We enrolled 232 and analyzed 223 patients, 89 of whom had pyogenic spinal infection. The median age was 55 years and 102 patients (45.7%) were male. The clinical characteristics associated with pyogenic spinal infection on multivariate analysis of study phase 1 included recent soft tissue infection or bacteremia (OR 13.5, 95% CI 3.6 to 50.7), male sex (OR 5.0, 95% CI 2.5 to 10.0), and fever in the ED or prior to arrival (OR 2.8, 95% CI 1.3 to 6.0). Among patients with SEA ( n  = 61), 49 (80.3%) had at least one historical risk factor, 12 (19.7%) had fever in the ED, and 8 (13.1%) had a history of intravenous drug use. Conclusion Male sex, fever, and recent soft tissue infection or bacteremia were associated with pyogenic spinal infection in this prospective ED cohort.