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Diagnostic delay of pediatric brain tumors in Israel: a retrospective risk factor analysis
Vered Shay1, Aviva Fattal-Valevski, Liana Beni-Adani
1Department of Pediatrics A, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. v_gothelf@hotmail.com
Insights
Delayed diagnosis of pediatric brain tumors (PBTs) is common in Israel, with 27% of cases experiencing unacceptable delays. Key reasons include delayed imaging and specific symptoms like torticollis, ataxia, and motor dysfunction.
Area of Science:
- Pediatric Oncology
- Neurology
- Diagnostic Imaging
Background:
- Pediatric brain tumors (PBTs) are a leading cause of childhood cancer morbidity and mortality.
- Previous research indicates significant delays between symptom onset and PBT diagnosis.
- Delayed diagnosis can result in acute complications and permanent neurological deficits.
Observation:
- A study analyzed 330 pediatric patients (0-18 years) diagnosed with brain tumors in Israel between 1996 and 2004.
- Family interviews were conducted for cases with suspected diagnostic delays.
- The average time to diagnosis was 7.7 months, with 50% experiencing symptomatic deterioration before diagnosis.
Findings:
- Unacceptable diagnostic delays occurred in 27% of pediatric brain tumor cases.
- The primary cause of delay was "delay in indicated imaging."
- Symptoms associated with delayed diagnosis included torticollis, ataxia, and motor dysfunction; specialist examinations also correlated with delays.
Implications:
- There is an "unacceptable rate" of diagnostic delay for PBTs in Israel.
- Increased awareness of PBT signs and symptoms among healthcare providers is crucial.
- Lowering the threshold for diagnostic imaging may help reduce delays and improve patient outcomes.
Purpose:
Pediatric brain tumors (PBTs) are the most common solid tumors and the leading cause of cancer-related morbidity and mortality in childhood. Previous studies have shown a significant delay between the onset of symptoms and the diagnosis of these tumors. Delayed diagnosis of PBTs may lead to acute situations and irreversible neurological damage. In this study, we looked for the incidence of delayed diagnosis of PBTs in Israel. We tried to find the reasons for these delays and the associated risk factors in order to provide a feedback to the system for improved education and earlier diagnosis.
Methods:
We analyzed the charts of 330 consecutive children aged 0-18 years diagnosed with brain tumors, between the years 1996 and 2004. In the cases where delay in diagnosis was suspected, further information was collected from a family interview.
Results:
The average "time to diagnosis" was 7.7 months (SD ± 16.7). Symptomatic deterioration from the first symptom until diagnosis was found in about 50% of the cases. Unacceptable delay in diagnosis was found in 27% of the children. The major reason for delay was "delay in indicated imaging." Symptoms that were found to be associated with delayed diagnosis were torticollis, ataxia, and motor dysfunction. Interestingly, the examination by specialists such as ophthalmologists or neurologists was also associated with delayed diagnosis.
Conclusions:
There is an unacceptable rate of delay in the diagnostic process of PBTs in Israel. Greater awareness and familiarity with signs and symptoms associated with these tumors and lowering imaging threshold might minimize this phenomenon.
