Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark.
Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.
Pediatr Blood Cancer. 2024 Jul;71(7):e31024. doi: 10.1002/pbc.31024. Epub 2024 May 6.
Childhood spinal tumors often present with musculoskeletal symptoms, potentially causing a misdiagnosis and delays in diagnosis and treatment. This study aims to identify, characterize, and compare children with spinal tumors who had prior musculoskeletal misdiagnoses to those without, analyzing clinical presentation, diagnostic interval, and outcome.
This retrospective cohort study evaluated all children aged 0-14 years diagnosed with a spinal tumor in Denmark from 1996 to 2018. The cohort was identified through the Danish Childhood Cancer Registry, and the registry data were supplemented with data from medical records. The survival was compared using the Kaplan-Meier method.
Among 58 patients, 57% (33/58) received musculoskeletal misdiagnoses before the spinal tumor diagnosis. Misdiagnoses were mostly nonspecific (64%, 21/33), involving pain and accidental lesions, while 36% (12/33) were rheumatologic diagnoses. The patients with prior misdiagnosis had less aggressive tumors, fewer neurological/general symptoms, and 5.5 months median diagnostic interval versus 3 months for those without a misdiagnosis. Those with prior misdiagnoses tended to have a higher 5-year survival of 83% (95% confidence interval [CI]: 63%-92%) compared to 66% (95% CI: 44%-82%) for those without (p = .15).
Less aggressive spinal tumors may manifest as gradual skeletal abnormalities and musculoskeletal symptoms without neurological/general symptoms, leading to misdiagnoses and delays.
儿童脊柱肿瘤常表现为肌肉骨骼症状，可能导致误诊和诊断及治疗延误。本研究旨在确定、描述和比较有和无先前肌肉骨骼误诊的脊柱肿瘤患儿，并分析其临床表现、诊断间隔和结局。
本回顾性队列研究评估了 1996 年至 2018 年期间在丹麦诊断为脊柱肿瘤的所有 0-14 岁儿童。该队列通过丹麦儿童癌症登记处确定，并通过病历数据对登记处数据进行补充。采用 Kaplan-Meier 法比较生存率。
在 58 例患者中，57%（33/58）在脊柱肿瘤诊断前存在肌肉骨骼误诊。误诊大多是非特异性的（64%，21/33），涉及疼痛和意外损伤，而 36%（12/33）为风湿性诊断。有先前误诊的患者肿瘤侵袭性较小，神经/全身症状较少，中位诊断间隔为 5.5 个月，而无误诊的患者为 3 个月。有先前误诊的患者 5 年生存率较高，为 83%（95%置信区间：63%-92%），而无误诊的患者为 66%（95%置信区间：44%-82%）（p=.15）。
侵袭性较小的脊柱肿瘤可能表现为逐渐出现的骨骼异常和肌肉骨骼症状，而无神经/全身症状，导致误诊和延误。
