Method DACI referrals from Lothian-based GPs (31/3/2010 to 1/4/2015) were categorised according to the symptom classifications of NICE 2005 and Kernick referral guidelines. Radiological findings were grouped into 1) normal/non-significant-incidental, 2) abnormal-significant, 3) intracranial tumour.
Results In total, 3257 head scans were performed, and after exclusions, 2938 records were analysed. Mean age was 55.6 (SD 18.56), 1748 (60%) females. Forty-two scans (1.43%) revealed significant intracranial tumours, including 17 (40%) metastases, 10 primary intracerebral tumours (24%), 8 pituitary (19%), 7 meningioma (17%). Non-significant incidental findings were observed on 571 (19%) scans, of which 175 (6%) correlated with symptoms. Based on NICE (2005) guidelines, 39% referrals were for ‘symptoms related to the CNS’, 16% for ‘Headache of raised ICP’, 18% for ‘Sub-acute deficits’ and 27% for ‘Unexplained headache’. Kernick guidelines classified 39% referrals red-flag, 25% orange-flag, and 36% yellow-flag symptoms. NICE ‘Symptoms related to CNS’ (OR 5.21, 95% CI = 1.81 to 14.9; PPV 2.9, 95% CI 2.0 to 4.0) and Kernick’s red-flag symptoms (OR 5.73, 95% CI =2.21 to 14.84; PPV 2.8, 95% CI = 1.9 to 3.9) were the only features to have significantly increased risk of brain tumour.
