Comelli Ivan, Lippi Giuseppe, Campana Valentina, Servadei Franco, Cervellin Gianfranco
Emergency Department, University Hospital of Parma, Parma, Italy.
Section of Clinical Biochemistry, University of Verona, Verona, Italy.
Ann Transl Med. 2017 Jul;5(13):269. doi: 10.21037/atm.2017.06.12.
Several patients with new onset brain tumors present to the Emergency Department (ED) complaining for new symptoms. Although information exists on symptom prevalence in the entire population of patients with brain tumors, little is known about the clinical presentation in ED. This retrospective study was planned to investigate clinical presentation and epidemiology of brain tumors firstly diagnosed in a large urban ED throughout a 10-year period.
All medical records of patients aged ≥18 years, discharged from our ED with a diagnosis of brain tumor were retrieved from the electronic hospital database during a 10-year period (2006 to 2015). The records were reassessed for selecting only brain tumors firstly diagnosed in the ED. The symptoms at presentation were divided in six categories: (I) headache; (II) seizures; (III) focal signs; (IV) altered mental status; (V) nausea/vomiting/dizziness; (VI) trauma. For all cases, the hospital record was retrieved, to obtain histologic classification of tumors. Patients with inflammatory neoformations were excluded from the study.
Overall, 205 patients with firstly diagnosed brain tumor were identified among 870,135 ED visits (i.e., <1%). Glial tumors were the most frequent (50% of the entire sample). No significant differences were found between mean age of patients in the different histologically based groups (meningiomas 66±14; glioblastomas 65±16 years; metastases 66±13 years; other miscellaneous 66±19 years). Focal signs accounted for more than 50% of all presentation signs/symptoms.
First presentation of brain tumor in the ED is not a rare occurrence, so that the emergency physicians should be aware of this possibility.
几位新发脑肿瘤患者前往急诊科（ED），主诉出现新症状。尽管已有关于脑肿瘤患者总体症状发生率的信息，但对于急诊科的临床表现却知之甚少。本回顾性研究旨在调查在一家大型城市急诊科10年间首次诊断出的脑肿瘤的临床表现和流行病学情况。
从电子医院数据库中检索出在10年期间（2006年至2015年）从我们急诊科出院、诊断为脑肿瘤的所有≥18岁患者的病历。重新评估这些记录，仅选择在急诊科首次诊断出的脑肿瘤。就诊时的症状分为六类：（I）头痛；（II）癫痫发作；（III）局灶性体征；（IV）精神状态改变；（V）恶心/呕吐/头晕；（VI）外伤。对于所有病例，检索医院记录以获取肿瘤的组织学分类。炎性新生物患者被排除在研究之外。
总体而言，在87,0135次急诊科就诊中，共识别出205例首次诊断为脑肿瘤的患者（即<1%）。胶质细胞瘤最为常见（占整个样本的50%）。在不同组织学类型的患者平均年龄之间未发现显著差异（脑膜瘤66±14岁；胶质母细胞瘤65±16岁；转移瘤66±13岁；其他66±19岁）。局灶性体征占所有就诊体征/症状的50%以上。
脑肿瘤在急诊科的首次就诊并不罕见，因此急诊医生应意识到这种可能性。
