From the Department of Orthopedic Surgery.
Radiology, Stanford University, Stanford, CA.
Pediatr Emerg Care. 2023 Dec 1;39(12):963-967. doi: 10.1097/PEC.0000000000003031. Epub 2023 Aug 12.
The timely diagnosis of primary bone malignancies in pediatric patients is critical to clinical outcomes. The purpose of this study is to investigate the initial presentation of pediatric bone sarcoma patients to an academic health care system and assess the current interval to diagnosis.
We conducted a retrospective review of pediatric patients (aged 1-18) with biopsy-proven diagnosis of osteosarcoma or Ewing sarcoma presenting between 2004 and 2020. All living patients had 1 year or more of follow-up. Primary outcomes were interval to diagnosis, clinical features on initial presentation, percent of patients with negative radiographic workup at initial presentation, and number of health care encounters before diagnosis.
Seventy-one patients (osteosarcoma, 51; Ewing sarcoma, 20) were included. Average age at presentation was 13.1 ± 3.3 years (range, 4.4-18.3). Average symptom duration was 5.4 ± 13.9 months (range, 0.1-84). Clinical features at initial presentation included limb/back pain (91.5% of patients), activity modification/pain medication use (78.9%), palpable mass (40.8%), night pain (35.2%), limp (25.4%), limb disuse (18.3%), and recent fever history (2.8%). Fourteen of 71 patients (19.7%) had negative radiographs at initial presentation. Average number of health care encounters before diagnosis was 1.9 ± 0.6 (range, 1.0-4.0), with most in the outpatient pediatrician clinics (81.2%) and emergency department (18.3%). Average time to diagnosis from initial presentation was 19.5 ± 65 days (range, 0-493); the 14 patients with initial negative radiographs had a statistically significant prolonged interval to diagnosis of 54 ± 134 days (range, 0-493; P = 0.018).
We found pediatric patients with primary bone sarcoma present with an average interval to diagnosis of 20 days. Twenty percent of patients had a significantly prolonged interval to diagnosis of 54 days. Clinical features suggest night pain is not a sensitive indicator. In patients of appropriate age with persistent unilateral pain in suspicious locations, early advanced imaging with magnetic resonance imaging should be considered.
及时诊断儿科原发性骨恶性肿瘤对临床结局至关重要。本研究旨在调查患儿就诊于学术医疗保健系统时的首发表现，并评估目前的诊断间隔时间。
我们对 2004 年至 2020 年间经活检证实为骨肉瘤或尤文肉瘤的患儿进行了回顾性研究。所有存活的患者均随访 1 年以上。主要结局为诊断间隔时间、首发时的临床特征、初始检查无异常的患者比例，以及诊断前的就诊次数。
71 例患者（骨肉瘤 51 例，尤文肉瘤 20 例）入组。平均发病年龄为 13.1±3.3 岁（4.4-18.3 岁）。平均症状持续时间为 5.4±13.9 个月（0.1-84 个月）。首发时的临床特征包括肢体/背痛（91.5%的患者）、活动受限/止痛药物使用（78.9%）、可触及肿块（40.8%）、夜间痛（35.2%）、跛行（25.4%）、肢体失用（18.3%）和近期发热史（2.8%）。71 例患者中，14 例（19.7%）在初始时的影像学检查无异常。诊断前的平均就诊次数为 1.9±0.6（1.0-4.0 次），大多数在儿科门诊（81.2%）和急诊（18.3%）。从首发到诊断的平均时间为 19.5±65 天（0-493 天）；14 例初始影像学检查无异常的患者诊断时间显著延长，为 54±134 天（0-493 天；P=0.018）。
我们发现，原发性骨肉瘤患儿的平均诊断间隔时间为 20 天。20%的患者的诊断间隔时间显著延长，为 54 天。临床特征提示夜间痛不是一个敏感的指标。对于年龄合适、持续存在可疑部位单侧疼痛的患者，应尽早考虑进行磁共振成像等高级影像学检查。
