Direct access CT for suspicion of brain tumour: An analysis of referral pathways in a population-based patient group
dc.contributor.author | Zienius, K | |
dc.contributor.author | Chak-Lam, I | |
dc.contributor.author | Park, J | |
dc.contributor.author | Ozawa, M | |
dc.contributor.author | Hamilton, W | |
dc.contributor.author | Weller, D | |
dc.contributor.author | Summers, D | |
dc.contributor.author | Porteous, L | |
dc.contributor.author | Mohiuddin, S | |
dc.contributor.author | Keeney, E | |
dc.contributor.author | Hollingworth, W | |
dc.contributor.author | Ben-Shlomo, Y | |
dc.contributor.author | Grant, R | |
dc.contributor.author | Brennan, PM | |
dc.date.accessioned | 2019-10-29T15:48:30Z | |
dc.date.issued | 2019-08-20 | |
dc.description.abstract | Background: Brain tumour patients see their primary care doctor on average three or more times before diagnosis, so there may be an opportunity to identify 'at risk' patients earlier. Suspecting a brain tumour diagnosis is difficult because brain tumour-related symptoms are typically non-specific. Methods: We explored the predictive value of referral guidelines (Kernick and NICE 2005) for brain imaging where a tumour is suspected, in a population-based patient group referred for direct access CT of the head. A consensus panel reviewed whether non-tumour findings were clinically important or whether further investigation was necessary. Results: Over a 5-year period, 3257 head scans were performed; 318 scans were excluded according to pre-specified criteria. 53 patients (1.8%) were reported to have intracranial tumours, of which 42 were significant (diagnostic yield of 1.43%). There were no false negative CT scans for tumour. With symptom-based referral guidelines primary care doctors can identify patients with a 3% positive predictive value (PPV). 559 patients had non-tumour findings, 31% of which were deemed clinically significant. In 34% of these 559 patients, referral for further imaging and/or specialist assessment from primary care was still thought warranted. Conclusion: Existing referral guidelines are insufficient to stratify patients adequately based on their symptoms, according to the likelihood that a tumour will be found on brain imaging. Identification of non-tumour findings may be significant for patients and earlier specialist input into interpretation of these images may be beneficial. Improving guidelines to better identify patients at risk of a brain tumour should be a priority, to improve speed of diagnosis, and reduce unnecessary imaging and costs. Future guidelines may incorporate groups of symptoms, clinical signs and tests to improve the predictive value. | en_GB |
dc.description.sponsorship | Brain Tumour Charity | en_GB |
dc.identifier.citation | Vol. 20, article 118 | en_GB |
dc.identifier.doi | 10.1186/s12875-019-1003-y | |
dc.identifier.grantnumber | GN000295 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/39385 | |
dc.language.iso | en | en_GB |
dc.publisher | BMC | en_GB |
dc.rights | © The Author(s) 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. | en_GB |
dc.subject | Brain tumor | en_GB |
dc.subject | Brain cancer | en_GB |
dc.subject | Early diagnosis of cancer | en_GB |
dc.subject | Primary health care | en_GB |
dc.subject | General practice | en_GB |
dc.subject | CT scan | en_GB |
dc.title | Direct access CT for suspicion of brain tumour: An analysis of referral pathways in a population-based patient group | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2019-10-29T15:48:30Z | |
dc.identifier.issn | 1471-2296 | |
dc.description | This is the final version. Available on open access from BMC via the DOI in this record | en_GB |
dc.description | Availability of data and materials: The dataset used during this study are available from the corresponding author in reasonable request. | en_GB |
dc.identifier.journal | BMC Family Practice | en_GB |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2019-07-31 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2019-08-20 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2019-10-29T15:44:18Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2019-10-29T15:48:35Z | |
refterms.panel | A | en_GB |
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Except where otherwise noted, this item's licence is described as © The Author(s) 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.