BASH GPwSI Group Audit: what do we image and why? Steven Elliot GPwSI Tier 2 Neurology Salford.
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Transcript of BASH GPwSI Group Audit: what do we image and why? Steven Elliot GPwSI Tier 2 Neurology Salford.
Aim
Assess adherence to and relevance of
the BASH guidelines on imaging patients with suspected brain tumour
Objectives
Record all patients seen Record numbers of patients scanned Record reasons for scans Reflect on non-guideline scans
Red flags
Papilloedema New epileptic seizure New onset cluster headache Abnormal findings on examination/neurological
symptoms History of cancer especially lung/breast Significant alteration consciousness, memory,
confusion or co-ordination.
Orange flags
Aggravated by exertion/Valsalva Headache associated with vomiting Headache which has increased in
frequency New onset >50 Headache waking from sleep Confusion
Methods
3 month baseline measurement 2010 Standard audit tool Anonymised collated analysis Reflection and recommendation Personal and/or group re-audit 2011
Baseline results
14 GPwSIs 3month period 895 patients 270 scans (30.16%) 173 (64%) Red or orange flags 54 red flags 16/270 “positive” (5.6%) Average scan rate 32.86%
Positive scansIndication 7 Intracranial hypotension Bilateral subdurals Grade 1 Chiari Left orbital abnormality Mild Chiari ChiariIndication 8 Sinus thickeningIndication 9 1cm lesion right temporal lobe Aneurysm Indication 13 CVST Multiple emboli Frontal lobe infarct Aneurysm Infarct left parietal lobe Left parietal infarct Glioma
Conclusions
Not adherent Need for personal reflection Need for group reflection Not clear that guidelines are relevant Need for non-cancer indications What do we do about the anxious patient? True positive rate 1.5%
New criteria 2 New undifferentiated headache where a pattern
has not emerged after 8 weeks Headache aggravated or precipitated by exertion
or Valsalva manoevre, cough or sex and not migraine
Headache associated with vomiting and not migraine
Headache which has increased in frequency/severity in the last six months despite appropriate treatment
New criteria 3
New headache in age >50 whose onset is less than 6 months ago
Headache that wakes from sleep that is not migraine
Thunderclap headache Patient whose anxiety is not relieved by
explanation and is aware of the implications of incidental findings
New criteria 4
New daily persistent headache Headache suggestive of low intracranial
pressure Recent onset headache in HIV or
immmunocompromised