Referral Guidelines

REFERRAL GUIDELINES

Many GPs ask "when should we organise a scan", '''when should we refer", or "to whom should we refer". We have therefore put together some referral guidelines to assist:

BACK OR NECK PAIN WITH SCIATICA OR BRACHIALGIA

  • MRI scan if:
    • leg or arm pain not improving after 6 weeks
    • significant weakness
    • symptoms of cauda equina dysfunction (urgent)
    • history of cancer
    • symptoms suggestive of infection (urgent)
  • Refer if:
    • leg or arm pain not improving after 6 weeks
    • significant weakness
    • symptoms of cauda equina dysfunction (urgent)
    • neck or back pain persist beyond 6 weeks
  • Refer to
    • neurosurgeon/spinal surgeon if:
      1. significant arm or leg pain, or weakness
      2. suspected cauda equina syndrome (extremely urgent- should be assessed the same day)
      3. suspected spinal abscess (extremely urgent- should be assessed the same day)
      4. suspected or proven tumour
    • pain specialist if neck or back pain is the main complaint, or if has seen several surgeons previously and surgery was not recommended

    BRAIN TUMOURS

    • Small brain tumours without surrounding oedema and headaches can be seen within a week, and should be referred to a neurosurgeon
    • Larger brain tumours (3cm or more) with headaches, surrounding oedema or mass effect, or any neurological deficits should be seen sooner
    • If cerebral oedema seen on CT or MRI around the tumour, consider starting dexamethasone 2-4mg orally tds or qid (also use a gastroprotective agent)
    • If an intracranial mass is reported as showing ‘ring enhancement’ on CT or MRI, an abscess is a possibility and this is even more urgent- the case should be discussed with a neurosurgeon
  • PARKINSON'S DISEASE OR TREMOR

  • If a patient with Parkinson’s disease or tremor does not have a neurologist, or is unhappy with the advice and treatment they are receiving from their neurologist, they should consider seeking a neurological opinion
  • If you or the patient are wondering whether they might be a candidate for deep brain stimulation (DBS), consider referral to neurosurgeon Professor Richard Bittar, who specialises in this field.
  • CHRONIC PAIN

  • If their pain or analgesic medication usage is escalating, consider referral to a pain specialist
  • For patients with work-related or accident-related pain which persists beyond 3 months, consider referral to Precision Ascend, a network pain management program
  • OTHER NEUROLOGICAL CONDITIONS

    Neurologists are best positioned to review a variety of neurological conditions, and also to perform nerve conduction studies

    URGENT REFERRALS

    For urgent referrals during office hours, please call 03 8862 0000 and ask for the mobile phone contact number for Prof Richard Bittar. If you would like his number for use after hours, please call our office and they will provide it to you. Otherwise, you can page Prof Bittar on 03 9387 1000

    SPECIALITY CLINICS

    We are building a number of multidisciplinary speciality clinics, including:

    Please visit our Multidisciplinary Clinics section for more information