Skip to content

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)

Research output: Contribution to journalArticle

Original languageEnglish
Number of pages8
JournalBMJ Open
Volume9
DOIs
DateAccepted/In press - 5 Jul 2019
DatePublished (current) - 30 Aug 2019

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 United Kingdom. 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 (PLR) 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 co-morbidity. 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 1.4-1.7%) followed by weakness 1.5% (1.3-1.7) and confusion 1.4% (1.3-1.5). Combining headache with other symptoms increased the PPV. For example, headache plus combined cognitive symptoms PPV 7.2% (6.0-8.6); plus weakness 4.4% (3.2-6.2), compared to headache alone PPV 0.1%.The diagnostic odds ratios 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.

    Research areas

  • Clinical Practice Research Datalink, diagnosis, symptoms, Brain tumour, neurological oncology, primary care

Download statistics

No data available

Documents

Documents

  • Full-text PDF (final published version)

    Rights statement: This is the final published version of the article (version of record). It first appeared online via BMJ Publishing Group at https://bmjopen.bmj.com/content/9/8/e029686 . Please refer to any applicable terms of use of the publisher.

    Final published version, 235 KB, PDF document

    Licence: CC BY

DOI

View research connections

Related faculties, schools or groups