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THE TOS STUDY CONTROL DATA: HOW WELL DO NEUROLOGY IN–PATIENTS RECALL BEING EXAMINED AND DOES IT MATTER?
  1. Adam Mulla,
  2. Jason Appleton,
  3. David Nicholl
  1. City Hospital, Sandwell and West Birmingham Hospitals NHS Trust

    Abstract

    Background We have recently developed a method of assessing the quality of neurological examination: the TOS score, which involves asking patients if they recall being examined with a Tendon hammer (T), Ophthalmoscope (O) and Stethoscope (S).1 33% of 93 patients referred to neurology in 2 hospitals could not recollect being examined with a tendon hammer and 48% said they had not been examined with an ophthalmoscope. In contrast, the majority (95.7%) remembered the use of a stethoscope in their examination. One of the limitations of the TOS study was potential recall bias, so we decided to measure TOS scores on a patient group we knew had been examined.

    Methods Prospective data collection over a four month period. We asked patients on discharge who were admitted under neurology whether they recalled being examined with a tendon hammer, ophthalmoscope and stethoscope during their hospital stay by showing them a standardised poster with a doctor using these three objects. Exclusion criteria included confused patients, those unable to communicate a response and those whose in–hospital stay was longer than a week.

    Results Of 45 patients discharged from a neurology ward at one hospital over a four month period with a median hospital stay of 2 days, 100% recalled being examined with a tendon hammer, 97.8% remembered being examined with an ophthalmoscope, and 86.7% recalled examination with a stethoscope. Two thirds of the patients were female with a median age of 47 years (range 17–65 years). The main diagnoses on discharge were: migraine (12 (26.7%)); stroke (9 (20%)); non–organic/functional (5 (11.1%)); transient ischaemic attack (2 (4.4%)); and demyelination (2 (4.4%)).

    Conclusions Although recall bias is a potential problem for the TOS score, this control data indicates that it should not be seen as a significant issue and does not negate the findings of our previous data collection that large numbers of in–patients with neurological problems are not been appropriately examined. TOS scores provide a method of quantifying the thoroughness of neurological examination and we are at present in the process of organising a multicentre study in six countries using TOS scores to establish how widespread this problem is globally.

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