title: Is primary care access to CT brain examinations effective?
abstract: OBJECTIVE
  Primary care access to CT head examinations could enable common neurological conditions to be managed within primary care. Outcome data from the first 8 years of a local service were used to identify effective referral criteria.
  
  
  METHODS
  Primary care head CT results from 1 March 1995 to 31 October 2003 were categorized as normal, incidental or significant findings. Normal reports were cross-referenced for referral to secondary care. Case notes with incidental or significant CT findings were reviewed for secondary care attendance and outcome.
  
  
  RESULTS
  Records of 1403/1645 CT head examinations (85%) were available for review. Of these 1403, 951 (67.8%) returned normal findings, 317 (22.6%) incidental findings and 135 (9.6%) significant findings. The commonest indication for referral was investigation of headaches (46.6%). Of the total 533 patients under 50 years of age, 13 (2.4%) yielded significant findings and all 13 showed other features in addition to headache. Of 314 cases presenting with focal neurology, 83 (26.4%) showed significant findings. 314 patients were referred from primary to secondary care. 189 had normal scans and 74 had findings described as incidental. 60% of secondary care referrals were for normal CT scans. In patients with focal neurology, 90 of 314 were referred, allowing 71% to be managed in primary care. Yield was also 0% for headaches, dizziness, visual disturbance or nausea and vomiting.
  
  
  CONCLUSIONS
  Primary care access to CT brain examinations is effective for patients with focal neurology, neurological symptoms or a known malignancy, but not for patients aged less than 50 years, or with uncomplicated headaches, dizziness or diplopia.
authors.affiliation: Department of Radiology, Pilgrim Hospital, Boston, UK. rachelbenamore@doctors.org.uk
authors.forename: R E
authors.initials: RE
authors.lastname: Benamore
authors.forename: D
authors.initials: D
authors.lastname: Wright
authors.forename: I
authors.initials: I
authors.lastname: Britton
mesh_terms: D000368:Aged; D005194:Family Practice / Q000706:statistics & numerical data*; D020773:Headache Disorders / Q000000981:diagnostic imaging*; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*