INTRODUCTION: Early diagnosis of brain tumours is one of the top 10 clinical research priorities identified by the neuro-oncology community. Headache is the most common first symptom (23%), is present in 50% by the time of initial hospital attendance and presentations are often delayed. Patients with tumour associated headaches often have unrecognised, or subtle, visual or cognitive signs or changes in behaviour/mood - headache “plus”. These cases often have a delayed presentation to primary care, when compared with patients presenting with focal symptoms or signs (e.g. hemiparesis, dysphasia) or seizures. We have used prospective national and local audit findings and stakeholder consensus to produce a Lothian electronic Protocol Based Referral for expedited GP open access brain CT imaging or referral for fast Optometry assessment within 24–48 hours. METHODS: Data form over 340 brain tumour patients involved in a Scottish audit of first presenting symptom and symptoms and signs at hospital presentation and neuro-cognitive data from 100 patients admitted for surgery with a brain tumour, were evaluated, looking at diagnostic delays and subtle finding found in patients presenting with headache as an early symptom. The Edinburgh Protocol was developed in collaboration with Macmillan Lead Cancer GP, Lead GP for Protocol Based Referral (PBR), Secondary Care Neuroscience specialists and the Scottish Lead for Optometry. Using the established Lothian GP Open Access CT scan policy and the Lothian electronic referral system for referral for scanning supplemented by the RefHelp system for GPs a new expedited PBR for 24–48 hour imaging and optometry evaluation was agreed. RESULTS: The Edinburgh Protocol for “Headache Plus” suspicion of cancer incorporates Scottish Cancer Referral Guidelines for Headache Suspicious of Cancer and co-existence of subtle behavioural or cognitive symptoms; a past history of cancer; or possible visual signs for fast referral for detailed optometry within 24–48 hours for evaluation of visual fields and fundi. Evaluation of a simple fast screening test of cognition (semantic verbal fluency (animals) that can be done in the GP clinic in 2–3 minutes is also being trialled. These features have been integrated into the electronic GP Protocol Based Referral pathway for open access CT brain scan within 24–48 hours rather than the neurological referral for clinical evaluation, usually “2 week wait”. The PBR includes detailed advice in the GP RefHelp system supported by educational videos on headaches and papilloedema and how to perform the semantic verbal fluency test. CONCLUSION: The Edinburgh Protocol for “Headache Plus” suspicion of cancer PBR is currently being trialled in Lothian Region, Scotland. The detailed evaluation including; referral times, frequency of positive scans, before and after comparisons with referral times in Lothian and impact on existing open access CT scanning numbers and waiting times are being assessed as part of a Brain Tumour Charity Grant for “Diagnosing Brain Tumours Earlier” programme.
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机译：简介：脑肿瘤的早期诊断是神经肿瘤学界确定的十大临床研究重点之一。头痛是最常见的首发症状（23％），到初次就诊时就已占50％，而且出诊通常会延迟。患有肿瘤相关性头痛的患者通常具有无法识别的或微妙的视觉或认知征兆或行为/情绪变化-头痛“加”。与表现出局灶性症状或体征（例如偏瘫，吞咽困难）或癫痫发作的患者相比，这些病例通常在初级保健中的诊治延迟。我们已经使用了预期的国家和地方审计结果以及利益相关方的共识来制作基于Lothian电子协议的转介，以便在24-48小时内快速进行GP开放式脑部CT成像或转介以进行快速验光。方法：对苏格兰医院首次就诊时出现症状，体征和体征的340例脑肿瘤患者的数据表进行了评估，并对100例接受脑瘤手术的患者的神经认知数据进行了评估，观察诊断延迟和细微差别在以头痛为早期症状的患者中发现。爱丁堡协议是与Macmillan Lead Cancer GP，基于协议的转诊（PBR）的Lead GP，二级保健神经科学专家和苏格兰的验光主管合作开发的。使用已建立的Lothian GP Open Access CT扫描策略和Lothian电子转诊系统进行转诊，并由RefHelp系统为GP补充，商定了用于24-48小时成像和验光评估的新的快速PBR。结果：《爱丁堡议定书》因怀疑“头疼加”而合并了苏格兰癌症转诊指南，该指南针对可疑头疼与微妙的行为或认知症状并存；癌症的既往史；或可能的视觉征兆，以便在24-48小时内快速转诊进行详细验光，以评估视野和眼底。也正在尝试对可以在GP诊所中进行2-3分钟的认知（语义语言流利性（动物）语义）快速筛查测试的评估，这些功能已集成到基于GP协议的电子转诊途径中，以实现开放获取在24-48小时内进行CT脑部扫描，而不是神经系统转诊以进行临床评估，通常是“ 2周等待”。PBR在GP RefHelp系统中提供了详细建议，其中包括关于头痛和乳头水肿以及如何实现语义口语流利性的教育视频结论：爱丁堡关于“头痛+”怀疑癌症PBR的协议目前正在苏格兰洛锡安地区进行试验，详细评估包括：转诊时间，阳性扫描的频率，与洛锡安转诊时间进行比较之前和之后以及影响脑部肿瘤慈善基金会“诊断脑部肿瘤”中评估了现有的开放式CT扫描数量和等待时间早期”计划。
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