title: A comparative study of referral patterns and management of patients with malignant brain tumours in Birmingham, UK, and Toronto, Canada.
abstract: The management of malignant brain tumours comprises a huge financial burden to any health care system. The referral pattern and initial management of this condition has not been widely investigated. Our main aim was to investigate and compare the referral patterns between two tertiary referral centres in Birmingham, UK, and Toronto, Canada, which have similar health care provision structures, but different financial resources, in order to examine whether there are any significant delays in the pathway of either system. The investigation consisted of a retrospective analysis of case records of patients identified as having malignant brain tumours who had been operated on at the two centres during the period 1997-1998. Data were collected on patient demographics, symptomatology at presentation, referral pattern, and time intervals between presentation, investigations, neurosurgical consultation and operation. Mann-Whitney U-tests of statistical significance were used to compare the two centres. Sixty-eight and 100 patients in Birmingham and Toronto, respectively, were identified from the registers following exclusion of patients with benign or low-grade tumours. Both centres were found to be similar with respect to sociodemographic factors of patients with malignant brain tumours. Referral patterns were analysed for presenting symptoms of neurological deficit and seizure, and found to be similar for both centres. Time intervals from presentation to investigation and from investigation to neurosurgical consultation were not significantly different between the two centres. Significant differences were found from neurosurgical consultation to operation (Birmingham, 3 days, and Toronto, 6 days, p = 0.006), and the duration of stay in hospital (Birmingham, 11 days, and Toronto, 2 days, p < 0.001). Although there are differences in the financial resources of the two tertiary centres our study reveals no significant differences in the referral pathway to operation.
authors.affiliation: Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK. i_kyprianou@hotmail.com
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kyprianou
authors.forename: Reza
authors.initials: R
authors.lastname: Nassab
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D004739:England / Q000453:epidemiology; D005260:Female; D005909:Glioblastoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D017678:Sex Distribution; D013997:Time Factors