Determinants of clinical effectiveness and significant neurological diagnoses in an urgent brain cancer referral pathway in the United Kingdom

Clinical Neurology and Neurosurgery
A J S Webb, R J Butterworth

Abstract

Cerebral tumours can rapidly progress to life-threatening complications yet referral pathways often result in non-significant diagnoses. We aimed to identify the determinants of referrals resulting in significant neurological diagnoses after specialist review. We reviewed all urgent brain cancer referrals to the neurology service at a British district general hospital between January 2009 and September 2013. Time to appointment, frequency of significant neurological diagnoses, appropriateness of referrals and referral heterogeneity across GP practices were measured as determinants of non-significant diagnoses. 31/105 patients received significant neurological diagnoses (29.5%), including ten (9.5%) tumours (7 malignant), although 2 patients were admitted prior to clinic. There was significant heterogeneity between primary care physicians in referral frequency (p = 0.008) and significant diagnoses (p = 0.005). Non-significant diagnoses were more common in inappropriate referrals and if patients were unaware of the potential diagnosis. Seizures or subacute focal symptoms were more likely to result in a significant neurological diagnosis than isolated headache syndromes (odds ratio 3.45, 1.34-18.4, p = 0.008). Despite a significan...Continue Reading

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Citations

Jun 13, 2017·Alzheimer's & Dementia : Diagnosis, Assessment & Disease Monitoring·Sebastiaan EngelborghsCharlotte E Teunissen
Sep 10, 2020·The Cochrane Database of Systematic Reviews·Robin GrantTheresa A Lawrie
Apr 18, 2017·Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA·R E ClarkL M Giangregorio

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