Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • actual or threatened cauda equina syndrome:
    • unexplained or unexpected loss of bladder or bowel function
    • perianal anaesthesia
    • bilateral nerve pain (leg pain below the knees)
    • progressive weakness / change in mobility or gait
    • clinical signs of spinal nerve root or spinal cord compression with severe/rapidly progressing neurological deficits including myelopathy
  • spinal tumour with significant pain and/or neurological deficit
  • spinal fracture/trauma with significant deformity, instability and/or neurological deficit
  • clinical suspicion of spinal infection

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Women's and Children's Health Network

Exclusions

  • paediatric congenital scoliosis - refer to orthopaedic spinal unit at Women’s and Children’s Hospital (WCH)
  • paediatric spinal fracture - refer to orthopaedic spinal unit at WCH

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • any intradural lesion including vascular malformations with stable symptoms or without symptoms
  • asymptomatic tethered cord with syringomyelia

Category 2 (appointment clinically indicated within 90 days)

  • spina bifida occulta including asymptomatic sacral dimple/skin tag where ultrasound cannot exclude intraspinal extension
  • incidental finding tethered cord without syringomyelia

Category 3 (appointment clinically indicated within 365 days)

  • asymptomatic arachnoid cyst

For information on referral forms and how to import them, please view general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander  
  • identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
  • interpreter required
  • child/parents demographic information including best contact details
  • relevant past medical/surgical history
  • current medications, allergies
  • history of presenting complaint including:
    • onset
    • duration
    • concerning features
    • past surgical procedures and year/s completed
    • additional treatments and management including frequency and outcomes
  • neurological examination findings
  • ultrasound (US) of lumbosacral spine / sacral dimple if concerned regarding spinal dysraphism
  • computed tomography (CT) or magnetic resonance imaging (MRI) spine
  • confirmation of diagnosis on imaging and associated reports including location, company, and accession number

Clinical management advice

An ultrasound should be conducted for infants with a sacral dimple as part of the initial assessment.

Spinal red flags include:

  • recent significant trauma
  • unexplained weight loss
  • history of cancer/malignancy
  • prolonged corticosteroid use
  • features of cauda equina
  • severe, worsening pain; especially at night
  • fever
  • recent serious illness/significant infection

Clinical resources

Consumer resources