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The paper by Chu et al1 presents retrospective case note review data on a large number of patients with brain tumours. The authors used a large-scale number crunching exercise to show brain tumour diagnosis can be delayed and that these children often present with non-specific symptoms making diagnosis more difficult. The data for this study is relatively old as cohorts examined were between 1989 and 1997 to 2006. The patients had symptoms up to 2 years before diagnosis and presented to primary and secondary care with increasing frequency until the diagnosis was reached. What is to be done? The tabloid press regularly complains that UK doctors are slow to see patients and slow to do diagnostic tests. In the UK the general practitioner (GP) has traditionally been a gatekeeper, trying to prevent the unnecessary overinvestigation of patients. Most GPs and paediatricians recognise that resources are limited but are themselves usually very concerned when a diagnosis is missed. Subtle symptoms in preschool children are particularly difficult. Headache is a very common symptom at all ages, with up to 20% of children complaining of this symptom at some time.2 Trying to decide who should be referred for a scan can be a challenge.
History and examination remains the cornerstone of diagnosis in medicine including paediatrics, but with non-specific symptoms and limited signs, or examination proving difficult, a …