The usefulness of symptoms alone or combined for general practitioners in considering the diagnosis of a brain tumour: A case-control study using the clinical practice research database (CPRD) (2000-2014)

Mio Ozawa, Paul M. Brennan, Karolis Zienius, Kathreena M. Kurian, William Hollingworth, David Weller, Robin Grant, Willie Hamilton, Yoav Ben-Shlomo*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

19 Citations (Scopus)
188 Downloads (Pure)

Abstract

Objectives To evaluate the utility of different symptoms, alone or combined, presented to primary care for an adult brain tumour diagnosis. Design and setting Matched case-control study, using the data from Clinical Practice Research Datalink (2000-2014) from primary care consultations in the UK. Method All presentations within 6 months of the index diagnosis date (cases) or equivalent (controls) were coded into 32 symptom groups. Sensitivity, specificity, positive predictive values (PPVs) and positive likelihood ratios were calculated for symptoms and combinations of symptoms with headache and cognitive features. Diagnostic odds ratios were calculated using conditional logistic regression, adjusted for age group, sex and Charlson comorbidity. Stratified analyses were performed for age group, sex and whether the tumour was of primary or secondary origin. Results We included 8,184 cases and 28,110 controls. Seizure had the highest PPV of 1.6% (95% CI 1.4% to 1.7%) followed by weakness 1.5% (1.3 to 1.7) and confusion 1.4% (1.3 to 1.5). Combining headache with other symptoms increased the PPV. For example, headache plus combined cognitive symptoms PPV 7.2% (6.0 to 8.6); plus weakness 4.4% (3.2 to 6.2), compared with headache alone PPV 0.1%. The diagnostic ORs were generally larger for patients <70 years; this was most marked for confusion, seizure and visual symptoms. Conclusion We found seizure, weakness and confusion had relatively higher predictive values than many other symptoms. Headache on its own was a weak predictor but this was enhanced when combined with other symptoms especially in younger patients. Clinicians need to actively search for other neurological symptoms such as cognitive problems.

Original languageEnglish
Article numbere029686
Number of pages8
JournalBMJ Open
Volume9
Issue number8
DOIs
Publication statusPublished - 30 Aug 2019

Keywords

  • brain tumour
  • clinical practice research datalink
  • diagnosis
  • neurological oncology
  • primary care
  • symptoms

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