Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
Br J Neurosurg. 2022 Feb;36(1):11-15. doi: 10.1080/02688697.2020.1823317. Epub 2020 Oct 5.
The National Institute for Health and Clinical Excellence (NICE) publish guidelines to facilitate the referral of patients with suspected malignancies, including CNS tumours, from primary care to the appropriate hospital services. We aimed to assess the impact and utility of the most recently revised guidelines, published in 2015, on our neurosurgical service.
MATERIALS & METHODS: We performed a retrospective analysis of the 2-week wait (2WW) referrals received by the neurosurgery department at our institution over a 3 and a half year period between 2015 and 2019. Details pertaining to the patient's clinical condition and ultimate diagnosis were collected from their medical records and assessed to determine whether the referral criteria were fulfilled.
Referrals for 101 patients were received over the study period (mean 29/year). Of these, 82 patients (81.2%) were referred based on symptoms, whilst 19 patients (18.8%) were referred with an abnormal brain scan. Seventy-five referrals (74%) were deemed compliant with the guideline criteria. The sensitivity and specificity of the updated guidelines was 90% (73-98%, 95% CI) and 32.4% (22-45%, 95% CI) respectively. The commonest reason for a non-compliant referral, in 21 cases (81%), was headache disorder without neurological deficit. Overall, 30 patients (30%) referred via the 2WW rule were found to have a brain tumour. With guideline adherence, the brain tumour detection rate was 3-fold higher (36.0% vs 11.5%, = 0.02).
An update to the NICE guidelines has coincided with an increase in the number of 2WW referrals received by our department, an increase in guideline compliant referrals and an improved rate of tumour detection, though a significant proportion of patients referred via this route ultimately do not require the services of a neurosurgeon. Greater provision of urgent imaging for general practitioners, in accordance with the current NICE guidelines, may reduce unnecessary neurosurgery consultations.
英国国家卫生与临床优化研究所（NICE）发布指南，以促进将疑似恶性肿瘤（包括中枢神经系统肿瘤）患者从初级保健转介至合适的医院服务。我们旨在评估 2015 年发布的最新修订指南对我们神经外科服务的影响和实用性。
我们对本机构神经外科在 2015 年至 2019 年期间的 3 年半内每周 2 次就诊（2WW）的转介进行了回顾性分析。从他们的病历中收集了与患者临床状况和最终诊断有关的详细信息，并进行了评估，以确定转介标准是否得到满足。
研究期间共收到 101 例患者的转介（平均每年 29 例）。其中，82 例（81.2%）患者因症状而转介，19 例（18.8%）患者因脑部扫描异常而转介。75 例（74%）转介符合指南标准。更新后的指南的敏感性和特异性分别为 90%（73-98%，95%CI）和 32.4%（22-45%，95%CI）。21 例（81%）不符合转介标准的常见原因是无神经功能缺损的头痛障碍。总的来说，通过 2WW 规则转介的 30 例患者中发现了脑肿瘤。在遵循指南的情况下，脑肿瘤的检出率提高了 3 倍（36.0%比 11.5%，=0.02）。
NICE 指南的更新恰逢我们科室收到的 2WW 转介数量增加，符合指南的转介数量增加，肿瘤检出率提高，但通过这种途径转介的患者中有相当一部分最终不需要神经外科医生的服务。根据当前 NICE 指南，为全科医生提供更紧急的影像学检查，可能会减少不必要的神经外科会诊。
