What criteria should I use to determine the urgency of referral for a patient with suspected cauda equina syndrome?

Criteria to determine urgency of referral for suspected cauda equina syndrome (CES):

• Refer immediately adults who have severe low back pain radiating into the leg combined with any new-onset disturbance of bladder, bowel, or sexual function, or new-onset perineal numbness, for urgent assessment of cauda equina syndrome.
• This immediate referral should be in line with local pathways to ensure rapid neurological assessment.

These criteria prioritise symptoms indicating possible nerve root compression affecting bladder and bowel control or perineal sensation, which are red flags for CES requiring urgent intervention.

In summary, the presence of severe low back pain plus any new bladder, bowel, sexual dysfunction, or perineal numbness mandates an immediate referral for suspected CES.

References: NICE NG127