The diagnosis of brain tumours in children: a guideline to assist healthcare professionals in the assessment of children who may have a brain tumour.
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.


CONCLUSIONS
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.
Wilne
Sophie
S
Department of Paediatric Oncology, Birmingham Children's Hospital NHS Trust, Birmingham, UK. swilne@googlemail.com
Koller
Karin
K
Collier
Jacqueline
J
Kennedy
Colin
C
Grundy
Richard
R
Walker
David
D
D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis*; D002648:Child; D003697:Delphi Technique; D002658:Developmental Disabilities / Q000209:etiology; D019317:Evidence-Based Medicine / Q000379:methods; D051271:Headache Disorders, Secondary / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009325:Nausea / Q000209:etiology; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014839:Vomiting / Q000209:etiology