Research by Dr Tracey Graves

All of our attendees carry out a piece of research in an area of MS clinical practice or treatment that interests them.

This snapshot gives you a quick idea of what they found and why. If you want to learn more, just click through to the full research report, or follow the links within the snapshot.

If you would like to contact the alumni who did the research, drop us a line and we’ll put you in touch where possible.

 

Aim

To find out whether people with suspected MS in a particular geographic area were being referred from their GP to a neurologist in line with current NICE guidance

Headlines

NICE states:
Before referring a person suspected of having MS to a neurologist, exclude alternative diagnoses by performing blood tests including: full blood count, inflammatory markers for example erythrocyte sedimentation rate, C‑reactive protein, liver function tests, renal function tests, calcium, glucose, thyroid function tests, vitamin B12, HIV serology.

NICE Guidance for MS (CG 186, Oct 2014), section 1.1.4

 

  • Anecdotally it seemed that this particular guidance was not being met in the researcher’s locality.
  • The analysis was across two full years of data (2016-2017)from a small, single-handed district general hospital (DGH).
  • The sample was chosen by looking at patient’s final clinical diagnosis such as optic neuritis, fatigue, sensory symptoms, or MS itself.
  • Any cases that could not have been MS were taken out of the sample before a thorough review of the remaining cases
  • The following was reviewed:
    • Clinical documentation: GP referral letter, clinic letter and investigation results
    • Person-centred information: patient demographics, presenting symptoms and signs and family history of MS

Key findings

26 cases of possible MS, as defined by the GP referral, were found in the two year period (12 in 2016 and 14 in 2017). Of these:

  • Most had some screening blood tests before referral but none had all those listed by NICE:
    • None had an HIV test
    • Only 46% had a vitamin B12 test, which was concerning given the high number of referrals for sensory symptoms
  • Most presented with multiple symptoms such as fatigue or sensory symptoms and had no detectable clinical signs.
    • Fatigue was often labelled as fybromyalgia; none of the patients with this diagnosis went on to be diagnosed with MS despite most of the referrals being in this category.
    • Having clinical neurological signs increased the likelihood of diagnosis though the rate was still very low.
  • Four patients had a family history of MS, which can prompt referral even if symptoms are not really compatible. One of the four was diagnosed with MS.
  • Only seven patients were diagnosed with MS across the two years giving a very low diagnosis rate of 0.45-0.57% in new patients.

Core recommendations

  • The retrospective analysis might not have given a complete case picture; a prospective study could be done in the future.

 

Take action

  • Read the full report
  • Contact the researcher to discuss their work (please put the name of the Snapshot as your title in our contact form)
  • Learn more about the issues raised in this report. Click the scattered links to access further information.