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Finding the Needle in the Hay Stack: Population-based Study of Prediagnostic Symptomatic Interval in Children With
Ran D Goldman1, D Douglas Cochrane2, Anita Dahiya1
1Pediatric Research in Emergency Therapeutics (PRETx) Program, Department of Pediatrics, University of British Columbia.
Insights
Diagnosing pediatric central nervous system (CNS) tumors can be delayed, with significant variability in time to diagnosis. Early recognition of symptoms like ataxia or paresis can shorten this critical interval.
Area of Science:
- Pediatric Oncology
- Neurology
- Diagnostic Medicine
Background:
- Central nervous system (CNS) tumors are a significant cause of morbidity and mortality in children.
- Delays in diagnosis for pediatric CNS tumors are a recognized challenge in clinical practice.
Purpose of the Study:
- To document and characterize the time to diagnosis for pediatric CNS tumors.
- To identify factors influencing the diagnostic interval in children with CNS tumors.
Main Methods:
- Retrospective chart review of pediatric CNS tumor cases from 2000-2016 in British Columbia, Canada.
- Analysis of medical records for 148 children diagnosed with CNS tumors.
- Calculation of prediagnostic symptomatic interval (PSI) and its components.
Main Results:
- The median time to diagnosis (PSI) was 62 days, with significant variability (average 197 days).
- One-third of cases were diagnosed after a single healthcare visit, while 7.7% required more than four visits.
- Tumors in the posterior fossa and symptoms of ataxia or paresis were associated with a shorter diagnostic interval.
Conclusions:
- Pediatric CNS tumors present a diagnostic challenge with considerable variation in the time to diagnosis.
- There is a need for increased awareness and education for families to recognize CNS tumor symptoms promptly.
- Further research may elucidate strategies to reduce diagnostic delays for improved pediatric outcomes.
Abstract:
Central nervous system (CNS) tumors in children are a devastating diagnosis and delay in diagnosis is well documented in the literature. The aim of this study was to document and characterize time to diagnosis of CNS tumors among children 0 to 17 years of age in a pediatric center. A retrospective chart review was conducted of medical records of children with CNS tumors from 2000 to 2016 in British Columbia, Canada and 148 reports were available for review. Average age at diagnosis was 87.8 months (SD=59.7; median=72). One third (30%) were diagnosed after a single visit to a health care provider and 11 (7.7%) after more than 4 visits. Median time to diagnosis (prediagnostic symptomatic interval [PSI]) was 62 days (average 197±341 d; range, 0 to 2047 d). Longest period was time from first symptom to first health care provider visit (PSI1, median 37 d). Tumors in the posterior fossa and symptoms of ataxia or paresis were associated with a significantly shorter PSI. CNS tumors in children continue to pose a diagnostic challenge with variability in time to diagnosis. Our population-based study suggests variability in time to diagnosis with a need for education of families to identify symptoms associated with CNS tumors.
