It has been previously reported that a substantial proportion of newly referred neurology out-patients have symptoms that are considered by the assessing neurologist as unexplained by 'organic disease'. There has however been much controversy about how often such patients subsequently develop a disease diagnosis that, with hindsight, would have explained the symptoms. We aimed to determine in a large sample of new neurology out-patients: (i) what proportion are assessed as having symptoms unexplained by disease and the diagnoses given to them; and (ii) how often a neurological disorder emerged which, with hindsight, explained the original symptoms. We carried out a prospective cohort study of patients referred from primary care to National Health Service neurology clinics in Scotland, UK. Measures were: (i) the proportion of patients with symptoms rated by the assessing neurologist as 'not at all' or only 'somewhat explained' by 'organic disease' and the neurological diagnoses recorded at initial assessment; and (ii) the frequency of unexpected new diagnoses made over the following 18 months (according to the primary-care physician). One thousand four hundred and forty-four patients (30% of all new patients) were rated as having symptoms 'not at all' or only 'somewhat explained' by 'organic disease'. The most common categories of diagnosis were: (i) organic neurological disease but with symptoms unexplained by it (26%); (ii) headache disorders (26%); and (iii) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow-up only 4 out of 1030 patients (0.4%) had acquired an organic disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients' original symptoms. Eight patients had died at follow-up; five of whom had initial diagnoses of non-epileptic attacks. Seven other types of diagnostic change with very different implications to a 'missed diagnosis' were found and a new classification of diagnostic revision is presented. One-third of new neurology out-patients are assessed as having symptoms 'unexplained by organic disease'. A new diagnosis, which with hindsight explained the original symptoms, rarely became apparent to the patient's primary care doctor in the 18 months following the initial hospital consultation.

Background. Patients whose symptoms are ' unexplained by disease ' often have a poor symptomatic outcome after specialist consultation, but we know little about which patient factors predict this. We therefore aimed to determine predictors of poor subjective outcome for new neurology out-patients with symptoms unexplained by disease 1 year after the initial consultation.Method. The Scottish Neurological Symptom Study was a 1-year prospective cohort study of patients referred to secondary care National Health Service neurology clinics in Scotland (UK). Patients were included if the neurologist rated their symptoms as ' not at all ' or only ' somewhat explained ' by organic disease. Patient-rated change in health was rated on a five-point Clinical Global Improvement (CGI) scale (' much better ' to ' much worse ') 1 year later.Results. The 12-month outcome data were available on 716 of 1144 patients (63 %). Poor outcome on the CGI (' unchanged ', ' worse ' or ' much worse ') was reported by 482 (67 %) out of 716 patients. The only strong independent baseline predictors were patients' beliefs [expectation of non-recovery (odds ratio [OR] 2.04, 95 % confidence interval [CI] 1.40-2.96), non-attribution of symptoms to psychological factors (OR 2.22, 95 % CI 1.51-3.26)] and the receipt of illness-related financial benefits (OR 2.30,. Together, these factors predicted 13 % of the variance in outcome.Conclusions. Of the patients, two-thirds had a poor outcome at 1 year. Illness beliefs and financial benefits are more useful in predicting poor outcome than the number of symptoms, disability and distress.

arthroplasty"[tw] OR "knee arthroplasty"[tw] OR "hip replacements"[tw] OR "knee replacements"[tw] OR "hip arthroplasties"[tw] OR "knee arthroplasties"[tw] OR "TJA"[tw] OR "TKA"[tw] OR "THA"[tw] OR "joint replacement"[tw] OR "joint arthroplasty"[tw] OR "TKR"[tw] OR "TJR"[tw] OR "THR"[tw] OR "lower limb arthroplasty"[tw] OR "lower limb arthroplasties"[tw] OR "lower extremity arthroplasty"[tw] OR "lower extremity arthroplasties"[tw] OR "lower limb joint replacement"[tw] OR "lower limb joint replacements"[tw] OR "lower extremity joint replacement"[tw] OR "lower extremity joint replacements"[tw] OR orthopedic*[tw] OR orthopaedic*[tw] OR acetabuloplast*[tw] OR (("lower limb"[tw] OR "lower extremity"[tw] OR "lower extremities"[tw] OR "hip"[tw] OR "knee"[tw] OR "joint"[tw] OR "joints"[tw]) AND ("replacement"[tw] OR "replacements"[tw] OR "arthroplasty"[tw] OR "arthroplasties"[tw])))

Level IV, retrospective case series.