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 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

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.

  • 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

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying 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.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.