EPI-09: SYSTEMATIC LITERATURE REVIEW TO STUDY SYMPTOMATOLOGY AND POPULATION BASED TOTAL DIAGNOSTIC INTERVAL (TDI) OF CHILDREN PRESENTING WITH BRAIN TUMOURS: EVIDENCE TO UPDATE AND EVALUATE THE ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH (RCPCH) CLINICAL GUIDANCE, THE FOCUS FOR THE HEADSMART BE BRAIN TUMOUR AWARE CAMPAIGN (WWW.HEADSMART.ORG.UK)

INTRODUCTION: HeadSmart Be Brain Tumour Aware was launched in 2011 to amplify the RCPCH clinical guidance on brain tumour diagnosis in children. Under “NHS Evidence” requirements five yearly evidence review is required. AIM: To identify new evidence in the literature, since the 2004 report and from analysis of HeadSmart TDI data to update the clinical guidance and compare UK TDI data to comparable population based reports. METHODS: Medline, Pubmed and Embase databases were systematically searched from 2005-2015 for data on signs, symptoms and TDI of all paediatric brain tumours. Effect size and pooled proportions were calculated. Subgroup analysis by age and location was also performed using UK HeadSmart TDI data. RESULTS: From 25,104 abstracts, 1002 papers were reviewed in full; 151 met the inclusion criteria, describing the signs/symptoms in 8682 children. The symptom profile remains unchanged from previous review. Increasing head circumference is newly identified as the commonest clinical sign in the under 3 age group. HeadSmart data analysis shows children with low grade glioma, midline supratentorial tumours and the TYA group to have the longest TDIs. The literature review identified 31 studies of TDI; 2 population based, 3 multi-centre, 26 single centre. CONCLUSIONS: Increasing head circumference in pre-school children will be incorporated into the new guidance. The TYA age group and midline tumour presentation will be the focus for consensus process for the revised guidance and campaign strategy. There are very few comparable population-based TDI data published. (Prepared on behalf of all HeadSmart: Be Brain Tumour Aware participants).