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  1. JP Appleton1,
  2. A Ilinca2,
  3. AG Lindgren2,
  4. A Puschmann2,
  5. M Habahbeh3,
  6. K Siddiqui4,
  7. R DeSilva5,
  8. M Jones6,
  9. R Butterworth7,
  10. DJ Nicholl1,8
  1. 1University Hospitals Birmingham NHS Foundation Trust
  2. 2Lund University, Sweden
  3. 3King Hussein Medical Centre, Amman, Jordan
  4. 4Al Ain Hospital, United Arab Emirates
  5. 5Romford Hospital, UK
  6. 6Salford Royal NHS Foundation Trust
  7. 7Milford Keynes Hospital
  8. 8City Hospital, Sandwell and West Birmingham Hospitals NHS Trust


Having previously demonstrated that in-patients referred to neurology at two UK hospitals were not fully examined prior to referral, we designed an audit with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention.

In-patients referred to neurology over a 4 month period in the UK, Jordan, Sweden and the United Arab Emirates were asked whether they recalled examination with a Tendon hammer, Ophthalmoscope and Stethoscope since admission. Results were disseminated to local medical teams and data were collected for a further 4 months. Pre and post-intervention data were available for 11 centres with 407 and 391 patients in each arm. 264 patients (64.86%) recalled examination with a tendon hammer pre-intervention, which significantly improved to 298 (76.21%) (p<0.001). 119 (29.24%) recollected ophthalmoscopy pre-intervention, which significantly improved to 149 (38.11%) (p=0.009). 321 (78.87%) recalled examination with a stethoscope pre-intervention, which significantly improved to 330 (84.4%) (p=0.045). Most patients were 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 internationally. This has implications for national neurological educators.

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