Clinical Factors Associated With Pediatric Brain Neoplasms

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Vomiting, headache history, and seizures may be clinical signs associated with malignant brain neoplasms in pediatric patients.
Vomiting, headache history, and seizures may be clinical signs associated with malignant brain neoplasms in pediatric patients.

In pediatric patients 7 and younger, a history of headache, vomiting, certain specific neurologic signs, and seizures are associated with a greater likelihood of having brain cancer, according to a retrospective study published in Pediatric Emergency Care.

The study investigators used a pediatric neuro-oncology clinic database to identify patients with brain cancer (n=131) who presented with headache. Researchers identified 203 patients with a headache diagnosis from 2 pediatric tertiary care emergency departments to serve as a comparator group.

Overall, brain neoplasms were more likely in patients 7 or younger (P <.01) and patients who had subjective gait difficulty (P <.01). 

A history of headaches was associated with a 0.5 times higher odds of having both brain cancer and headache at presentation compared with controls (95% CI, 0.3-0.9; P =.03), as determined after multivariable regression analysis.

In addition, vomiting was associated with a greater risk for having brain cancer compared with control cases (early morning 1.8 [95% CI, 1.0-3.2; P =.04]; non-early morning 6.6 [95% CI, 2.0-21.7; P <.01]). Patients with neurologic signs (95% CI, 5.4-19.4; P <.01) as well as associated seizures (95% CI 3.8-30.7; P <.01) also had higher odds of having brain neoplasms.

Clinical documentation of historical health data or objective examination findings may have limited the findings. The study was also limited in its ability to assess for other causes of headaches, including nonneoplastic-related hydrocephalus, sinus venous thrombosis, and arteriovenous malformations.

Despite the limitations, the findings from this study may help “expand a list of potential risk factors to be considered by clinicians and, importantly, used in future studies to develop a clinical decision rule.”

Reference

Sheridan DC, Waites B, Lezak B, et al. Clinical factors associated with pediatric brain neoplasms versus primary headache: a case-control analysis. Pediatr Emerg Care [published online November 14, 2017] doi:10.1097/PEC.0000000000001347

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