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Delay in the diagnosis of paediatric brain tumours
Milana Dobrovoljac1, Heinz Hengartner, Eugen Boltshauser
1Department of Oncology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
Insights
Delays in diagnosing pediatric brain tumors are common, with many cases taking over a month to be identified. Increased awareness and thorough examinations are crucial for earlier detection and better outcomes.
Area of Science:
- Pediatric Oncology
- Neurology
- Diagnostic Medicine
Background:
- Primary brain tumors are a significant concern in pediatric oncology.
- The pre-diagnostic period for pediatric brain tumors often involves delays in diagnosis.
- Understanding clinical presentation and diagnostic delays is vital for improving patient outcomes.
Purpose of the Study:
- To analyze the clinical presentation of pediatric brain tumors.
- To identify reasons for diagnostic delays in children with primary brain tumors.
- To assess the pre-diagnostic symptomatic interval (PSI) in pediatric brain tumor patients.
Main Methods:
- Retrospective analysis of 252 children diagnosed with primary brain tumors.
- Assessment of the pre-diagnostic symptomatic interval (PSI), including parental and doctor's delay.
- Correlation of PSI with patient age, gender, tumor histology, and location.
Main Results:
- The median PSI was 60 days, with significant parental and doctor delays.
- Only 33% of brain tumors were diagnosed within the first month of symptom onset.
- PSI correlated with patient age and tumor histology, but not gender, year, or location.
- Common initial symptoms varied by age, including headache, vomiting, seizures, and behavioral changes.
Conclusions:
- The majority of patients (88%) develop further symptoms, indicating a need for heightened awareness.
- A detailed medical history and repeated, correctly interpreted neurological examinations are essential for earlier diagnosis.
- Earlier diagnosis can increase the probability of complete tumor resection and improve prognosis.
Unlabelled:
The pre-diagnostic period of 252 children (median age 6.3 years, range 0-16.9 years) with primary brain tumours was assessed to analyse their clinical presentation and reasons for any delay in diagnosis. The median pre-diagnostic symptomatic interval (PSI) was 60 days (range 0-3010 days) with a parental delay of 14 days (range 0-2310 days) and a doctor's delay of 30 days (range 0-3010 days). Only 33% of brain tumours were diagnosed within the 1st month after the onset of signs/symptoms. PSI correlated significantly with patients' age and tumour histology, but not with gender, year of diagnosis or tumour location (supratentorial hemispheric, supratentorial midline, infratentorial). In children older than 2 years, most common initial signs/symptoms were headache, nausea/vomiting, seizures, squint/diplopia, ataxia and behavioural changes. In children younger than 2 years, most common initial signs/symptoms were seizures, vomiting, head tilt and behavioural changes. These signs/symptoms are by no means pathognomonic features of brain tumours, making the diagnosis in the early course often difficult.
Conclusion:
given the fact that the vast majority of patients (88% in the present study) develop further signs/symptoms, a high level of awareness, a detailed medical history and repeated correctly interpreted neurological examinations should lead to an earlier diagnosis and to a higher probability of total tumour resection.