Department of Pediatric Oncology, IOP-GRAACC-Federal University of Sao Paulo, Sao Paulo, Brazil.
Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil.
Childs Nerv Syst. 2024 Nov;40(11):3545-3552. doi: 10.1007/s00381-024-06629-9. Epub 2024 Oct 3.
Childhood central nervous system (CNS) tumors tend to have a longer time interval until diagnosis than other pediatric malignancies. The aim is to describe the time to diagnosis among Brazilian pediatric patients treated at a tertiary center and explore associated factors.
Cross-sectional study; application of questionnaires to parents of children with CNS tumors during outpatient visit or inpatient care.
One hundred parents participated between August and November 2023. The median age of the children at diagnosis was 7.2 years old. Low-grade glioma (LGG) was the most common tumor type (37%), followed by medulloblastoma (24%). The most frequent symptoms were morning and/or persistent vomiting and headache. The mean prediagnostic symptomatic interval (PSI) was 150 days. The mean parental interval was shorter than the medical (58.1 days vs 92.8 days). LGGs and tumors located in the central area had longer intervals to diagnosis than other tumors (296 vs 54 days) (p = 0.005) and (206 vs 155 days) (p = 0.007), respectively. Despite 81% of the patients undergoing pediatric routine follow-up, 87% of them had been diagnosed at an emergency department. Children attended by the same physician had a shorter mean interval (18.2 vs 88.3 days) than those assisted by different professionals (p = 0.015). The mean time for referral to our specialized center was 23 days.
This study is a crucial step in recognizing barriers to early diagnosis of CNS tumors in a middle-income country as low awareness of signs/symptoms by parents and health professionals, aiming to provide opportunities for intervention strategies to reduce the time to diagnosis.
与其他儿科恶性肿瘤相比，儿童中枢神经系统 (CNS) 肿瘤的诊断时间间隔往往更长。本研究旨在描述巴西一家三级治疗中心治疗的小儿 CNS 肿瘤患者的诊断时间，并探讨相关因素。
横断面研究；在门诊或住院期间向 CNS 肿瘤患儿的家长发放调查问卷。
2023 年 8 月至 11 月期间，共有 100 位家长参与了此项研究。患儿诊断时的中位年龄为 7.2 岁。低级别胶质瘤（LGG）是最常见的肿瘤类型（37%），其次是髓母细胞瘤（24%）。最常见的症状是晨吐和/或持续性呕吐和头痛。平均预诊断症状间隔（PSI）为 150 天。父母间隔的平均值短于医疗间隔（58.1 天比 92.8 天）。LGG 和位于中枢区域的肿瘤比其他肿瘤的诊断间隔更长（296 天比 54 天）（p=0.005）和（206 天比 155 天）（p=0.007）。尽管 81%的患者接受了儿科常规随访，但仍有 87%的患者在急诊科就诊。由同一位医生诊治的患儿平均间隔时间更短（18.2 天比 88.3 天），而由不同医生诊治的患儿间隔时间更长（p=0.015）。转诊至我们的专业中心的平均时间为 23 天。
这项研究是认识中低收入国家 CNS 肿瘤早期诊断障碍的重要一步，因为家长和卫生专业人员对体征/症状的认识不足，旨在为干预策略提供机会，以缩短诊断时间。
