From Symptom to Diagnosis – the Pre-Diagnostic Symptomatic Interval of Paediatric Central Nervous System Tumours in Austria

Publication date: Available online 18 August 2017
Source:Pediatric Neurology
Author(s): Amedeo A. Azizi, Kirsten Heßler, Ulrike Leiss, Chryssa Grylli, Monika Chocholous, Andreas Peyrl, Johannes Gojo, Irene Slavc
BackgroundChildren with central nervous system (CNS) tumours may present with a multitude of symptoms, ranging from elevated intracranial pressure (ICP) to focal neurologic deficit. In every-day practice, some signs may be misleading, thereby causing prolonged pre-diagnostic symptomatic intervals (PSI). PSI are longer for paediatric brain tumours than for other childhood malignancies. This study evaluated PSI, and parental and diagnostic intervals for paediatric patients with CNS tumours in Austria. It also considered socio-economic factors.ProcedurePatients ≤ 19 years of age treated at the Medical University of Vienna and diagnosed during the years 2008-2013 were included. Patients diagnosed incidentally or by screening were excluded.ResultsTwo hundred and twelve consecutive patients were included in the study. They reflected the expected spectrum of CNS tumours. Patients presented with a median of five symptoms at diagnosis, most frequently with signs of elevated ICP. The median PSI was 60 days (0 days – 7 years), the median parental interval 30 days (0 days – 6.7 years) and the median diagnostic interval 3 days (0 days – 6.5 years).In spinal tumours alone (n=7) median PSI was 70 days (10 days – 7 years), and 3/7 patients had a PSI longer than 320 days.Young age, higher tumour grade and ataxia were associated with shorter PSI. Localisation in the supratentorial midline, histology of craniopharyngioma and endocrine symptoms prolonged PSI. There was a clear trend for longer PSI in non-native speakers.ConclusionsResults are comparable to other industrialised countries. However, long delays in diagnosis of CNS tumours still occur, urging increased awareness.



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