PT  - JOURNAL ARTICLE
AU  - Karolis Zienius
AU  - Chak Ip
AU  - Mio Ozawa
AU  - Robin Grant
AU  - Yoav Ben-Shlomo
AU  - Paul M Brennan
TI  - Primary care direct access cerebral imaging in Lothian, Scotland: a 5-year retrospective analysis of referrals, assessment of utility of referral guidelines, and determination of incidence of abnormalities
AID  - 10.3399/bjgp18X697481
DP  - 2018 Jun 01
TA  - British Journal of General Practice
PG  - bjgp18X697481
VI  - 68
IP  - suppl 1
4099  - http://bjgp.org/content/68/suppl_1/bjgp18X697481.short
4100  - http://bjgp.org/content/68/suppl_1/bjgp18X697481.full
SO  - Br J Gen Pract2018 Jun 01; 68
AB  - Background Direct Access Cerebral Imaging (DACI) from Primary Care has been recommended by NICE for patients with symptoms suspicious of cancer.Aim We analysed the predictive value of the NICE (2005) and Kernick referral guidance for suspicion of brain tumour in a real-world settingMethod 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.Conclusion Referral guidelines confirm the urgency for rapid access head imaging for symptoms ‘highly suspicious’ of brain tumour. We are now assessing diagnostic value of different symptom complexes for intracranial tumour including headache-plus.