INITIAL NEUROLOGICAL ASSESSMENT: A PILOT STUDY OF THE ‘GLASGOW NEUROSCREEN’

Introduction Clinical experience suggests that patients admitted to general medical wards will rarely undergo a neurological examinationif the presenting complaint is perceived to be primarily non– neurological. With evolution of the presentation, any later formal neurologicalassessment not benefit from a record of the temporal evolution of the neurologicalsigns. We present a rapid neurologicalscreen which may ultimately be used in patients presenting without neurologicalsymptoms and may improve recording of the neurological examination. In this study we performed initial validation for subjects with neurologicalsymptoms presenting to our neurologyunit. Methods Two protocols were devised to accommodate both ambulant and non–ambulant patients (Figure 1). A third year medical student (FR) performed the screening examination blind to the formal examination. These results were compared to results from the formal neurological examinationperformed in either our acute neurologyward, day investigation unit, or the outpatient clinic. Results from formal examination by a neurologyregistrar or consultant were determined from retrospective review of case notes. For inpatients only, we stipulated that the inter–examination interval should be Results Twelve non–ambulant and eighteen ambulant patients were identified. For non–ambulant patients, the screening examination detected any abnormality with sensitivity and specificity of 100%. Agreement was excellent (Scott9s Pi=1; CI=0.42 to 1). Results for the subgroups of the exam were as follows: Eyes; sensitivity=100%, specificity=87.5%: face; sensitivity=50%, specificity=93%: arms; sensitivity=67%, specificity=100%: legs; sensitivity=83%, specificity=83%. For ambulant patients the screening examination detected any abnormality with a sensitivity of 69% and a specificity of 60%. Agreement was fair (Scott9s Pi=0.25; CI=–0.17 to 0.63). Results for the subgroups of the exam were as follows; Eyes–sensitivity=75%, specificity=78%; face–sensitivity=100%, specificity=100%; arms–sensitivity=100%, specificity=100%; legs–sensitivity=100%, specificity=77%. Conclusion A screening examination by a medical student showed excellent agreement with formal examination in those with significant neurologicalimpairment (non–ambulant patients). In ambulant patients it performed less well, but with a sensitivity of 69 still represents and advance on ‘examination not done’. We argue that further studies to improve sensitivity of this proposed screening examination are indicated to promote adoption in a general medical setting for patients without neurologicalsymptoms.