Clinical Characteristics of Pediatric Patients Presenting to the Emergency Department with a New Diagnosis of CNS Tumor

Background: Historically, a substantial lag time occurs from symptom onset and diagnosis of pediatric CNS tumors. Although this has been extensively studied, there does not appear to be any literature looking at emergency department history and physical examination and its accuracy in predicting a child to have a CNS tumor.

Methods: To aid in early identification of these tumors, we sought to determine signs and symptoms occurring in pediatric patients presenting to the emergency department diagnosed with a CNS tumor. A secondary outcome measure was to compare the ED clinical exam to the neurooncologist exam to check for concordance.

Results: Table 1 shows presenting characteristics by tumor histology. The most common location of the tumor was cerebellum (31.8%) followed by cerebral hemisphere (29.4%) and brain stem (18.3%). The most common tumor types were astrocytoma (31.8%), medulloblastoma (14.3%), and craniopharyngioma (9.5%). Symptoms of headache, vomiting, vision changes and altered school performance differed by type of CNS lesion. 91.7% of those diagnosed with Craniopharyngioma had headaches (p=.07). Eighty three percent of those diagnosed with Diffuse intrinsic pontine glioma (DIPG) or Medulloblastoma had vomiting (p=.04). Fifty percent of those diagnosed with PNET or Craniopharyngioma had vision changes (p=.06). Seventeen percent of those diagnosed with Germ cell tumors and 11.1 % of those diagnosed with Medulloblastoma had altered school performance (p=.06). Table 2 shows the sensitivity, specificity, and likelihood ratio comparing the ED exam to the neurooncologist exam. Abnormal sensory exam in the ED yielded a 100% sensitivity and 95.7 % specificity with a Likelihood Ratio (LR) of 23. Cranial nerve abnormalities yielded a 90.7% sensitivity and 61% specificity and a LR of 2.3.

Conclusion: Some historical symptoms and physical exam findings were significantly correlated with the diagnosis of pediatric brain tumor in children presenting to the emergency department. Recognition of these signs and symptoms may facilitate an earlier diagnosis for patients with pediatric brain tumors. There was a high degree of concordance with the neurooncologist in certain exam findings. A development of a streamlined focused examination may aid in early diagnosis of CNS tumors in the acute setting.