TY - JOUR
T1 - The usefulness of symptoms alone or combined for general practitioners in considering the diagnosis of a brain tumour
T2 - A case-control study using the clinical practice research database (CPRD) (2000-2014)
AU - Ozawa, Mio
AU - Brennan, Paul M.
AU - Zienius, Karolis
AU - Kurian, Kathreena M.
AU - Hollingworth, William
AU - Weller, David
AU - Grant, Robin
AU - Hamilton, Willie
AU - Ben-Shlomo, Yoav
PY - 2019/8/30
Y1 - 2019/8/30
N2 - 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.
AB - 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.
KW - brain tumour
KW - clinical practice research datalink
KW - diagnosis
KW - neurological oncology
KW - primary care
KW - symptoms
UR - http://www.scopus.com/inward/record.url?scp=85071740387&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2019-029686
DO - 10.1136/bmjopen-2019-029686
M3 - Article (Academic Journal)
C2 - 31471440
AN - SCOPUS:85071740387
SN - 2044-6055
VL - 9
JO - BMJ Open
JF - BMJ Open
IS - 8
M1 - e029686
ER -