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日本一家机构中儿童脑肿瘤的初始症状和诊断延迟情况

Initial symptoms and diagnostic delay in children with brain tumors at a single institution in Japan.

作者信息

Yamada Yuji, Kobayashi Daiki, Terashima Keita, Kiyotani Chikako, Sasaki Ryuji, Michihata Nobuaki, Kobayashi Toru, Ogiwara Hideki, Matsumoto Kimikazu, Ishiguro Akira

机构信息

Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.

Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan.

出版信息

Neurooncol Pract. 2020 Oct 6;8(1):60-67. doi: 10.1093/nop/npaa062. eCollection 2021 Feb.

Abstract

BACKGROUND

A prolonged interval between onset of symptoms and diagnosis of childhood brain tumor is associated with worse neurological outcomes. The objectives of this study are to determine factors contributing to diagnostic delay and to find an interventional focus for further reduction in the interval between symptom onset and diagnosis in Japan.

METHODS

We retrospectively analyzed 154 patients younger than 18 years with newly diagnosed brain tumors who visited our institution from January 2002 to March 2013.

RESULTS

The median age at diagnosis was 6.2 years and the median total diagnostic interval (TDI) was 30 days. Patients with low-grade tumors and cerebral midline tumor location had significantly long TDI. Durations between the first medical consultation and diagnosis (diagnostic interval, DI) were exceedingly longer for patients with visual, hearing, or smelling abnormalities as the first symptom (median, 303 days). TDI and DI of patients who visited ophthalmologists or otolaryngologist for the first medical consultation were significantly longer. Among these patients, longer DI was associated with worse visual outcome.

CONCLUSION

Raising awareness of brain tumor diagnosis among ophthalmologists and otolaryngologists may reduce diagnostic delay and may improve the neurological impairment of children with brain tumors in Japan.

摘要

背景

儿童脑肿瘤症状出现至诊断的间隔时间延长与较差的神经学预后相关。本研究的目的是确定导致诊断延迟的因素,并找到一个干预重点,以进一步缩短日本症状出现至诊断的间隔时间。

方法

我们回顾性分析了2002年1月至2013年3月期间到我院就诊的154例新诊断为脑肿瘤的18岁以下患者。

结果

诊断时的中位年龄为6.2岁,中位总诊断间隔(TDI)为30天。低级别肿瘤和脑中线肿瘤部位的患者TDI显著延长。以视觉、听觉或嗅觉异常为首发症状的患者,首次就诊至诊断的时间(诊断间隔,DI)极长(中位时间为303天)。首次就诊于眼科医生或耳鼻喉科医生的患者的TDI和DI显著更长。在这些患者中,较长的DI与较差的视觉预后相关。

结论

提高眼科医生和耳鼻喉科医生对脑肿瘤诊断的认识,可能会减少诊断延迟,并可能改善日本脑肿瘤患儿的神经功能损害。

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