title: Imaging patients with suspected brain tumour: guidance for primary care.
abstract: The number of referrals by primary care practitioners to secondary care neurology services, particularly for headache, may be difficult to justify. Access to imaging by primary care practitioners could avoid referral without compromising patient outcomes, but the decision to refer is based on a number of complex factors. Due to the paucity of rigorous evidence in this area, available data are combined with expert opinion to offer support for GPs. The study suggests management for three levels of risk of tumour: red flags>1%; orange flags 0.1-1%; and yellow flags<0.1% but above the background population rate of 0.01%. Clinical presentations are stratified into these three groups. Important secondary causes of headache where imaging is normal should not be overlooked, and normal investigation does not eliminate the need for follow-up or appropriate management of headache.
authors.affiliation: St Thomas Health Centre, Exeter. su1838@eclipse.co.uk
authors.forename: David P
authors.initials: DP
authors.lastname: Kernick
authors.forename: Fayyaz
authors.initials: F
authors.lastname: Ahmed
authors.forename: Anish
authors.initials: A
authors.lastname: Bahra
authors.forename: Andrew
authors.initials: A
authors.lastname: Dowson
authors.forename: Giles
authors.initials: G
authors.lastname: Elrington
authors.forename: Manuela
authors.initials: M
authors.lastname: Fontebasso
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Giffin
authors.forename: Sue
authors.initials: S
authors.lastname: Lipscombe
authors.forename: Anne
authors.initials: A
authors.lastname: MacGregor
authors.forename: Richard
authors.initials: R
authors.lastname: Peatfield
authors.forename: Stuart
authors.initials: S
authors.lastname: Weatherby
authors.forename: Tom
authors.initials: T
authors.lastname: Whitmarsh
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
mesh_terms: D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis*; D005194:Family Practice; D006261:Headache / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed