EPI-01: REVIEW OF CLINICAL PRESENTATION AND TRAJECTORY OF PEDIATRIC PATIENTS (0-18 YEARS OF AGE) WITH A DIAGNOSIS OF PRIMARY BRAIN TUMOUR (BT) IN A PEDIATRIC TERTIARY CENTER

INTRODUCTION: Recognition of BT remains a challenge among pediatric patients. Few studies have treated initial presentation, clinical evolution and healthcare system factors in the same cohort. OBJECTIVES: To determine the presentation patterns and health care trajectory of patients with primary BT. Compare presentation patterns between different age groups and different settings of diagnosis. METHOD: Through a retrospective chart review of patients <18 yo diagnosed with primary BT by neuroimaging between 2003 and 2014. RESULTS: 288 patients were identified. Mean age at diagnosis: 7.44 ± 0.29 years. 35% consulted only once prior to diagnosis. Mean time between the onset of symptoms and diagnosis: 147 ± 19 days; or first consultation: 84 ± 14 days. Most frequent symptoms/signs at onset and diagnosis were respectively: headache (44% vs 59%, p <0.001), nausea/vomiting (31% vs 58%, p <0.001), gait abnormalities (10% vs 32%, p <0.001). 129 patients (45%) were diagnosed in an Emergency Department (ED), while 96 patients (33%) were diagnosed as outpatients. Symptoms/signs that differed for those diagnosed in ED were: headache (71% vs 42%, p <0.001), nausea/vomiting (73 % vs 32%, p <0.001), lethargy (26% vs 9%, p = 0.002). Clinical presentations of infants <3 yo (20%) differed from other age groups. They presented mostly with lethargy (35%), irritability (33%), macrocephaly (26%). CONCLUSION: Headache is the most common presenting symptom of BT. Diagnosis is most frequently made in the ED. The delay between the onset of symptoms and diagnosis is up to five months, mostly after multiple consultations.