The TOS2 Study: an International Multi-Centre Audit Assessing the Standard of Neurological Examination (P4.190)

Objective:To establish whether the standard of neurological examination can be improved by use of a simple patient assessment score.Background:In a previous audit we demonstrated that in-patients referred to neurology at United Kingdom (UK) hospitals were not fully examined prior to referral;1 we therefore designed a larger audit with 80[percnt] power to detect a 10[percnt] increase in tendon hammer or ophthalmoscope use following an educational intervention.Methods:In-patients referred to neurology over a 4 month period (in hospitals in the UK (10), Jordan(1), Sweden (2)and the United Arab Emirates(1)) were asked whether they recalled being examined with a tendon hammer (T), ophthalmoscope (O) and stethoscope (S) since admission. The results were disseminated to local medical teams using various techniques (including Grand Round presentations, email, posters, discounted equipment). Data were then collected for a further 4 month period post-intervention.Results:Pre-intervention and post-intervention data were available for 11 centres with 407 u0026 391 patients in each arm respectively. Median age of patients was 51 (range 13-100) and 49 (range 16-95) years respectively, with 44.72[percnt] and 44.76[percnt] being male in each group. 264 patients (64.86[percnt]) recalled being examined with a tendon hammer in the pre-intervention arm, which significantly improved to 298 (76.21[percnt]) (pu003c0.001). Only 119 patients (29.24[percnt]) recollected examination with an ophthalmoscope pre-intervention, which significantly improved to 149 (38.11[percnt])(p=0.009). The majority of patients (321 (78.87[percnt])) pre-intervention recalled examination with a stethoscope, which significantly improved to 330 (84.4[percnt]) to a lesser extent (p=0.045).Conclusions:Results indicate that most patients are not fully examined prior to neurology referral yet a simple assessment score and educational intervention can improve the standard of neurological examination. This is the largest and - to our knowledge - only study to assess the standard of neurological examination worldwide. This has implications for national neurological educators. Disclosure: Dr. Appleton has nothing to disclose. Dr. Ilinca has nothing to disclose. Dr. Lindgren has received personal compensation for activities with Pfizer Inc. and Boehringer Ingelheim Pharmaceuticals as a scientific advisory board participant and/or speaker. Dr. Puschmann has nothing to disclose. Dr. Habahbeh has nothing to disclose. Dr. Siddiqui has nothing to disclose. Dr. De Silva has nothing to disclose. Dr. Jones has nothing to disclose. Dr. Butterworth has nothing to disclose. Dr. Willmot has nothing to disclose. Dr. Hayton has nothing to disclose. Dr. Lunn has received personal compensation for activities with Baxter Pharmaceuticals, CSL Behring, and LFB. Dr. Nightingale has nothing to disclose. Dr. Nicholl has nothing to disclose.