Clinical presentation and delay in the diagnosis of CNS tumours in children

Abstract

Background: CNS tumours represent the second commonest malignancy in childhood. Objective: to describe the presenting symptoms and delay of the first visit to a health centre, time to diagnosis and to the beginning of treatment. Methods and materials: A retrospective study using the records of children with CNS tumours treated at the Sótero del Rio Hospital Oncology Unit, Santiago, Chile between November 1994 and July 2002. The data was analyzed using the t-test. Results: Headache (62.5%) and vomiting (56.2%) were the most frequent symptoms. The median delay to presentation was 1 week, and common presentation was to primary care centers (45.2%) and Emergency (25.8%). The correct diagnosis was made in 32.2% at the first visit. The median delay time between presentation and diagnosis was 4 weeks, with a mean number of presentations of 2. The mean delay between diagnosis and treatment was 6 days for surgery, 37 days for chemotherapy and 42 days for radiotherapy. Discussion: Headache and vomiting are the most frequent presenting symptoms, their association with neurological symptoms must alert medical staff. The first presentation is early, the delay being produced because of a low index of suspicion, especially at primary care centres. Regarding treatment, surgery was performed early, but chemotherapy and radiotherapy were delayed. We conclude that it is necessary to improve the index of suspucion, especially at primary care centres, and also to improve post surgery management, avoiding delays for the remaining therapy.