title: Determinants of clinical effectiveness and significant neurological diagnoses in an urgent brain cancer referral pathway in the United Kingdom.
abstract: BACKGROUND
  Cerebral tumours can rapidly progress to life-threatening complications yet referral pathways often result in non-significant diagnoses. We aimed to identify the determinants of referrals resulting in significant neurological diagnoses after specialist review.
  
  
  METHODS
  We reviewed all urgent brain cancer referrals to the neurology service at a British district general hospital between January 2009 and September 2013. Time to appointment, frequency of significant neurological diagnoses, appropriateness of referrals and referral heterogeneity across GP practices were measured as determinants of non-significant diagnoses.
  
  
  RESULTS
  31/105 patients received significant neurological diagnoses (29.5%), including ten (9.5%) tumours (7 malignant), although 2 patients were admitted prior to clinic. There was significant heterogeneity between primary care physicians in referral frequency (p = 0.008) and significant diagnoses (p = 0.005). Non-significant diagnoses were more common in inappropriate referrals and if patients were unaware of the potential diagnosis. Seizures or subacute focal symptoms were more likely to result in a significant neurological diagnosis than isolated headache syndromes (odds ratio 3.45, 1.34-18.4, p = 0.008).
  
  
  CONCLUSIONS
  Despite a significant number of important neurological diagnoses and tumours, there were frequent inappropriate or low-risk referrals resulting in non-significant diagnoses, particularly if a headache syndrome was the sole reason for referral.
authors.affiliation: Nuffield Department of Neurosciences, University of Oxford, Oxford, UK. Electronic address: alastair.webb@ndcn.ox.ac.uk.
authors.forename: A J S
authors.initials: AJ
authors.lastname: Webb
authors.affiliation: Milton Keynes Hospital, Milton Keynes, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Butterworth
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006261:Headache / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000628:therapy; D009460:Neurologic Examination; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D018570:Risk Assessment; D012640:Seizures / Q000175:diagnosis; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Clinical neurology; Headache; Neuro-oncology; Tumour