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    Multiple sclerosis, from referral to confirmed diagnosis: an audit of clinical practice.

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    Authors
    Kelly, S B
    Chaila, E
    Kinsella, K
    Duggan, M
    McGuigan, C
    Tubridy, N
    Hutchinson, M
    Affiliation
    Department of Neurology, St Vincent's University Hospital, Dublin, Ireland., sb.kelly@st-vincents.ie
    Issue Date
    2012-02-01T10:28:44Z
    MeSH
    Adolescent
    Adult
    Female
    Humans
    Male
    *Medical Audit
    Middle Aged
    Multiple Sclerosis/*diagnosis
    *Practice Guidelines as Topic
    Referral and Consultation/*standards
    Young Adult
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    Citation
    Mult Scler. 2011 Aug;17(8):1017-21. Epub 2011 Apr 5.
    Journal
    Multiple sclerosis (Houndmills, Basingstoke, England)
    URI
    http://hdl.handle.net/10147/207470
    DOI
    10.1177/1352458511403643
    PubMed ID
    21467186
    Abstract
    BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) guidelines recommend a timeline of 6 weeks from referral to neurology consultation and then 6 weeks to a diagnosis of multiple sclerosis (MS). OBJECTIVES: We audited the clinical management of all new outpatient referrals diagnosed with MS between January 2007 and May 2010. METHODS: We analysed the timelines from referral to first clinic visit, to MRI studies and lumbar puncture (LP) (if performed) and the overall interval from first visit to the time the diagnosis was given to the patient. RESULTS: Of the 119 diagnoses of MS/Clinically Isolated Syndrome (CIS), 93 (78%) were seen within 6 weeks of referral. MRI was performed before first visit in 61% and within 6 weeks in a further 27%. A lumbar puncture (LP) was performed in 83% of all patients and was done within 6 weeks in 78%. In total, 63 (53%) patients received their final diagnosis within 6 weeks of their first clinic visit, with 57 (48%) patients having their diagnosis delayed. The main rate-limiting steps were the availability of imaging and LP, and administrative issues. CONCLUSIONS: We conclude that, even with careful scheduling, it is difficult for a specialist service to obtain MRI scans and LP results so as to fulfil NICE guidelines within the optimal six-week period. An improved service would require MRI scans to be arranged before the first clinic visit in all patients with suspected MS.
    Language
    eng
    ISSN
    1477-0970 (Electronic)
    1352-4585 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1177/1352458511403643
    Scopus Count
    Collections
    St. Vincent's University Hospital

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