Avoiding missed diagnosis of child brain tumours

Fortunately, life-threatening illness is rare among children in the UK. However, central nervous system tumours are the second most common cause of malignancy in a child, after leukaemia.

The difficulty doctors face when diagnosing a brain tumour is that the presenting symptoms often mimic common, less severe illnesses, and may be intermittent or fluctuate in severity.

Signs and symptoms

The presenting symptoms of a brain tumour in a child may be very non-specific, and in very young children it can be difficult to obtain a clear history of symptoms.

Doctors are advised to follow the relevant NICE guidance and actively consider the diagnosis if patients have persistent symptoms - including headaches, vomiting, lethargy or behavioural change.

NICE also states that doctors should:

'Take into account the insight and knowledge of parents and carers when considering making a referral for suspected cancer in a child or young person. Consider a referral for children if their parent or carer has persistent concern or anxiety about the child's symptoms, even if the symptoms are most likely to have a benign cause'.

An urgent referral should be made if the primary healthcare physician is unable to undertake an adequate examination.

Avoiding delays

The MDU's advice to doctors to help reduce the risk of delay in making a diagnosis includes:

  • Consider relevant guidelines, such as those from NICE.
  • Where a potential diagnosis is made with neurological signs, make an urgent or immediate referral in line with NICE guidance.
  • Be aware of the importance that guidance places on persistent parental anxiety as a reason for referral.
  • Document a thorough history and details of your examination in the patient's records, along with the differential diagnosis and management plan. Record negative as well as positive findings.
  • Make patients and/or their parents/guardians aware of the importance of a further medical consultation should their symptoms not resolve. You might wish to consider putting in place a computerised warning system to flag up patients for whom you have concerns.
  • If a diagnosis is missed or delayed, apologise to the patient and/or their family, explain what happened and what you propose to do to put things right, if possible.
  • Have an adverse incident system in place, to analyse any delay in diagnosis or other problem which may occur.

This guidance was correct at publication 06/11/2017. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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