The diagnosis of brain tumours in children: a guideline to assist healthcare professionals in the assessment of children who may have a brain tumour
- 1Department of Paediatric Oncology, Birmingham Children's Hospital NHS Trust, Birmingham, UK
- 2Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
- 3School of Nursing, Faculty of Medicine and Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- 4Department of Child Health, University of Southampton, Southampton General Hospital, Southampton, UK
- 5Children's Brain Tumour Research Centre, Academic Division of Child Health, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Correspondence to Sophie Wilne, Department of Paediatric Oncology, Birmingham Children's Hospital NHS Trust, Birmingham, UK
Contributors DW, JC, RG and CK devised the study. SW and KK undertook the Delphi process. SW drafted the manuscript. All authors commented on manuscript drafts and contributed to the final version.
- Accepted 29 December 2009
- Published Online First 6 April 2010
Background Brain tumours are the commonest solid tumour in children. Children with brain tumours are frequently unwell for months prior to diagnosis. A prolonged period between symptom onset and diagnosis is associated with increased morbidity.
Objective To develop an evidence-based clinical guideline to support healthcare professionals in the identification, assessment and investigation of children presenting with symptoms and signs that could be due to a brain tumour.
Methods A systematic literature review with a meta-analysis and cohort study provided the guideline evidence base. A multi-disciplinary workshop and Delphi consensus voting were used to translate the evidence into a clinical guideline. The results of the literature review and cohort study have been previously published.
Results 20 healthcare professionals and parents participated in the workshop. 77 statements were generated detailing the presenting features of childhood brain tumours, factors that could be used to discriminate brain tumours from other less serious conditions and possible referral pathways for children with brain tumours. 156 healthcare professionals agreed to participate in the Delphi process; 112 completed the first round and 88 completed all three rounds (attrition rate 21%). 64 statements reached consensus. The final guideline comprises 76 recommendations advising on the symptomatology of childhood brain tumours, assessment of children who may have a brain tumour and recommendations for selection for and timing of central nervous system imaging.
Conclusion Implementation of this guideline may support clinicians in the identification and timely imaging of children with brain tumours. This may reduce the morbidity currently experienced by many children with brain tumours.
Funding The guideline was developed with a grant (grant number RG10044964) from the Big Lottery Fund. The grant was applied for by The Samantha Dickson Brain Tumour Trust (registered charity no.1060627) on behalf of the Children's Brain Tumour Research Centre, University of Nottingham. The funders had no role in study design, data collection, data analysis, data interpretation or writing of this report.
Competing interests None.
Ethics approval This study was conducted with the approval of the Nottingham 2 REC.
Provenance and peer review Not commissioned; externally peer reviewed.