Who is referred to neurology clinics?—The diagnoses made in 3781 new patients

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Abstract

Objective

Information on the nature and relative frequency of diagnoses made in referrals to neurology outpatient clinics is an important guide to priorities in services, teaching and research. Previous studies of this topic have been limited by being of only single centres or lacking in detail. We aimed to describe the neurological diagnoses made in a large series of referrals to neurology outpatient clinics.

Method

Newly referred outpatients attending neurology clinics in all the NHS neurological centres in Scotland, UK were recruited over a period of 15 months. The assessing neurologists recorded the initial diagnosis they made. An additional rating of the degree to which the neurologist considered the patient's symptoms to be explained by disease was used to categorise those diagnoses that simply described a symptom such as ‘fatigue’.

Results

Three thousand seven hundred and eighty-one patients participated (91% of those eligible). The commonest categories of diagnosis made were: headache (19%), functional and psychological symptoms (16%), epilepsy (14%), peripheral nerve disorders (11%), miscellaneous neurological disorders (10%), demyelination (7%), spinal disorders (6%), Parkinson's disease/movement disorders (6%), and syncope (4%). Detailed breakdowns of each category are provided.

Conclusions

Headache, functional/psychological disorders and epilepsy are the most common diagnoses in new patient referral to neurological services. This information should be used to shape priorities for services, teaching and research.

Introduction

Information on the nature and relative frequency of diagnoses made in referrals to neurology outpatient clinics is an important guide to priorities in services, teaching and research. Published studies suffer several types of limitations [1], [2], [3], [4], [5], [6], [7]. Several have been of single neurologist's practice [1], [2], [6], [7], others have had small samples [3], [5], or have been lacking in diagnostic detail [4].

In order to provide better information we set out to: (a) describe in detail the nature and relative frequency of neurological diagnoses received by a large sample of new referrals to NHS neurology out patient clinics throughout Scotland, and (b) the demographic characteristics of the patients in each diagnostic category.

Section snippets

Methods

The data reported here were collected by the Scottish Neurological Symptoms Study. This was a prospective, multi-centre, cohort study of neurology outpatients in Scotland, UK. Ethical approval for the study was granted by a Multi-centre Research Ethics Committee MREC.

Recruitment

Between 16/12/2002 and 26/02/2004, 4299 new patients attended the specified clinics. Of these, 138 were excluded (80 were cognitively impaired, 17 had language difficulties, 15 were considered by the doctor as unsuitable for the study, 12 were too physically disabled or ill, in 10 no reason was recorded, 3 had severe behavioural problems, and 1 was too young). Of the remaining 4161 patients 269 refused to participate, 101 did not complete the assessment and 10 neurologist diagnoses were not

Discussion

This study provides detailed data on the neurological diagnoses made by a representative sample of neurologists in 3781 new patients (36) referred from across Scotland. Whilst it was not surprising to find that headache was the commonest category of diagnosis made, it was striking that the second commonest category was patients with functional or psychological diagnoses.

Conflict of interest

None.

Funding

Clinical Research Audit Group (CRAG) NHS Scotland and the Chief Scientist Office of the Department of Health of the Scottish Government.

Acknowledgments

we would like to thank all the neurologists and general practitioners who took part in this study; S Tennant, L Alder, J Sim, M Selkirk, D McConachie—the researchers who administered the questionnaires.

References (16)

  • C. Nimnuan et al.

    Medically unexplained symptoms: an epidemiological study in seven specialities

    J Psychosom Res

    (2001)
  • P. Fink et al.

    Somatoform disorders among first-time referrals to a neurology service

    Psychosomatics

    (2005)
  • G.D. Perkin

    An analysis of 7836 successive new outpatient referrals

    J Neurol Neurosurg Psychiatry

    (1989)
  • D.L. Stevens

    Neurology in Gloucestershire: the clinical workload of an English neurologist

    J Neurol Neurosurg Psychiatry

    (1989)
  • A. Hopkins et al.

    A record of patient encounters in neurological practice in the United Kingdom

    J Neurol Neurosurg Psychiatry

    (1989)
  • Association of British Neurologists (Service Committee)

    UK audit of the care of common neurological disorders

    (1991)
  • C.M. Wiles et al.

    General Practice referrals to a department of neurology

    J R Coll Physicians

    (1996)
  • P. Maddison

    Neurology training in the United Kingdom: a diagnostic analysis of over 5000 patients

    J Neurol

    (2005)
There are more references available in the full text version of this article.

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