DETECTION OF INTRACRANIAL TUMORS, SUBARACHNOID HEMORRHAGES, AND SUBDURAL HEMATOMAS IN PRIMARY-CARE PATIENTS - A REPORT FROM ASPN .2.

Background. The initial diagnosis of intracranial tumor, subarachnoid hemorrhage (SAH), and subdural hematoma (SDH) can be difficult. This s tudy was undertaken to determine the incidence and presenting signs an d symptoms of these disorders in primary care settings, and to determi ne whether a more aggressive investigative strategy for patients with headache is justifiable. Methods. Weekly return cards and a chart audi t were used to collect data over a 19-month period on every patient wh o had a new diagnosis of intracranial tumor, SAH, or SDH. Age and sex reports were collected annually. Results. Twenty-five new tumors, 17 S AHs, and 8 SDHs were reported in 58 practices (a rate of 12/100,000 pa tients per year). Only one half of these patients had headaches, and n o abnormalities were found on neurological examination of many. Diagno sis was delayed in only four patients with headache caused by a brain tumor and in three patients with SAHs. Diagnosis was delayed in two of the latter because of false-negative CT scans. Conclusions. Although clinical findings and CT scans are not reliable indicators, clinicians are able to detect the majority of these rare conditions without undu e delay by selecting a small subset of patients for further investigat ion. More extensive use of CT scans appears to be a weak strategy to i mprove detection of these serious disorders, as increased use would le ad to increased health care costs and unintended adverse effects, and provide little benefit.