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Delay in the diagnosis of pediatric central nervous system tumors: data from a single tertiary care center
Farrah Bashir1, Samreen Aamir2, Soha Zahid3
1Department of Oncology, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan. Farrah.Bashir@aku.edu.
Insights
Diagnosis delays for pediatric central nervous system (CNS) tumors are significant, particularly in Pakistan. Increased public and primary care awareness is crucial for timely referrals and improved outcomes in pediatric CNS tumor management.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Epidemiology of Childhood Cancers
Background:
- Central nervous system (CNS) tumors are a leading cause of solid tumors in children.
- Prompt diagnosis is critical for effective treatment and better prognoses in pediatric CNS tumor cases.
- This study investigates diagnostic delays for pediatric CNS tumors at a Pakistani tertiary care hospital.
Purpose of the Study:
- To analyze the diagnostic delay in pediatric central nervous system (CNS) tumors.
- To identify factors influencing the time to diagnosis for CNS tumors in children.
- To inform strategies for improving early detection and management of pediatric CNS tumors.
Main Methods:
- Retrospective analysis of pediatric patients (0-21 years) diagnosed with CNS tumors.
- Data collected from Aga Khan University Hospital (AKUH) between January 2018 and December 2023.
- Time to diagnosis measured from symptom onset to the first radiological diagnosis.
Main Results:
- 338 pediatric patients were included; 57.1% were male, median age 9 years.
- Headache (55.6%) and vomiting (47.9%) were the most frequent symptoms.
- Median diagnostic delay was 2.1 months; referral to specialists averaged 3 months. Early diagnosis correlated with vomiting and tumor location (p<0.001).
- Medulloblastoma and high-grade gliomas had faster diagnosis (within 2 months) compared to low-grade gliomas and ependymomas (p=0.003).
Conclusions:
- Significant delays exist in referring pediatric CNS tumor patients to neuro-oncologists/neurosurgeons.
- Enhanced public and primary healthcare provider awareness is essential for early symptom recognition.
- Timely referral to specialized centers is key for improving early diagnosis and outcomes of pediatric CNS tumors.
Background:
Central nervous system (CNS) tumors are among the most common solid tumors in pediatric patients. Timely diagnosis is crucial for effective management and improved outcomes. This study aimed to analyze the delay in diagnosis of CNS tumors at a single tertiary care hospital in Pakistan.
Methods:
A retrospective study was conducted on patients aged 0-21 years diagnosed with CNS tumors at Aga Khan University Hospital (AKUH) between January 2018 and December 2023. Data was reviewed from medical records via the hospital's database. Time to diagnosis was recorded as the duration between initial symptoms and the first radiological diagnosis.
Results:
Three hundred thirty-eight patients were identified; 57.1% were male with a median age of 9 years (interquartile range (IQR): 5-14). The most common symptom was headache (55.6%), followed by vomiting (47.9%). Low-grade gliomas (24.3%) were predominant, followed by high-grade gliomas (21.6%) and medulloblastoma (14.2%). The median duration from symptom onset to diagnosis was 2.1 months (IQR: 1.0-6.3), whereas the median duration of symptoms to oncologist/neurosurgeon visit was 3 months (IQR: 1.0-8.6). Early tumor diagnosis correlated significantly with vomiting (p < 0.001) and tumor location (p < 0.001). Tumor diagnosis was within 2 months for medulloblastoma and high-grade glioma and more than 2 months for low-grade glioma and ependymoma (p = 0.003).
Conclusion:
Our findings depict a delay in referral to a neuro-oncologist or neurosurgeon. This warrants increased awareness among the general population and primary healthcare professionals. Public awareness campaigns and early recognition of symptoms followed by timely referral to tertiary healthcare centers are key for early diagnosis of pediatric CNS tumors.
