Audit of the effect of introducing local guidelines for referral for carotid duplex scanning

Guidelines for referral of patients for carotid duplex scanning were introd uced stating that scans were only indicated for patients with hemispheric l ocalising symptoms or asymptomatic bruits. A 19% reduction in referral rate was seen for new scans in a one year period. The number of "inappropriate" requests fell from 27.6% in 1994 to 12.8% in 1995. There was no reduction in the numbers of patients identified with effectively occult asymptomatic disease who may have been suitable for surgery in the same period. Guidelin e introduction had the effect of reducing unnecessary scans without any eff ect on the overall pick-up, rate for carotid disease.