ABSTRACT
Objective Childhood brain tumors belong to the cancer type with the longest diagnostic delay, the highest health care utilization prior to diagnosis, and the highest burden of long-term sequelae. We aimed to clarify whether prior musculoskeletal diagnoses in childhood brain cancer were misdiagnoses and whether it affected the diagnostic delay.
Study design In this retrospective, chart-reviewed case-control study we compared 28 children with brain tumors and a prior musculoskeletal diagnosis to a sex and age-matched control group of 56 children with brain tumors and no prior musculoskeletal diagnosis. Using the Danish registries, the cases were identified from consecutive cases of childhood brain cancers in Denmark over 23 years (1996-2018).
Results Of 931 children with brain tumors, 3% (28/931) had a prior musculoskeletal diagnosis, of which 39% (11/28) were misdiagnoses. The misdiagnoses primarily included torticollis-related diagnoses which tended to a longer time interval from first hospital contact until a specialist was involved: 35 days (IQR 6-166 days) compared to 3 days (IQR 1-48 days), p = 0.07. When comparing the 28 children with a prior musculoskeletal diagnosis with a matched control group without a prior musculoskeletal diagnosis, we found no difference in the non-musculoskeletal clinical presentation, the diagnostic time interval, or survival.
Conclusion Musculoskeletal misdiagnoses were rare in children with brain tumors and did not affect the diagnostic time interval or survival. The misdiagnoses consisted primarily of torticollis- or otherwise neck-related diagnoses.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The Danish Data Protection Agency approved the study on August 31, 2021 (1-45-70-90-21).
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
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Footnotes
Funding/Support: No sponsors or funders (other than the named authors) played any role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript. The project received grants from: Arvid Nilsson’s (grant number 1780631), Danish Childhood Cancer Foundation (grant number 2017-1945 and 2020-6653), and Ølufgård Memorial Fund (grant number 25734)
Conflict of Interest Disclosures: The authors have no conflicts of interest to disclose.
Financial Disclosure: The authors have no financial relationships relevant to this article to disclose
Data Availability
All relevant data are within the manuscript and its Supporting Information files
Abbreviations
- CNS
- Central nervous system
- DCCR
- Danish Childhood Cancer Registry
- DNPR
- The Danish National Patient Registry
- IQR
- interquartile range.