Delay in the Diagnosis of Pediatric Brain Tumors in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Autor:	Irshad HA; Medical College, Aga Khan University, Karachi, Pakistan., Shariq SF; Medical College, Aga Khan University, Karachi, Pakistan., Khan MAA; Medical College, Aga Khan University, Karachi, Pakistan., Shaikh T; Medical College, Aga Khan University, Karachi, Pakistan., Kakar WG; Medical College, Aga Khan University, Karachi, Pakistan., Shakir M; Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan., Hankinson TC; Department of Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Enam SA; Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2024 Jul 10. Date of Electronic Publication: 2024 Jul 10.
DOI:	10.1227/neu.0000000000003097
Abstrakt:	Background and Objectives: Vague symptoms and a lack of pathognomonic features hinder the timely diagnosis of pediatric brain tumors (PBTs). However, patients in low- and middle-income countries (LMICs) must also bear the brunt of a multitude of additional factors contributing to diagnostic delays and subsequently affecting survival. Therefore, this study aims to assess these factors and quantify the durations associated with diagnostic delays for PBTs in LMICs. Methods: A systematic review of extant literature regarding children from LMICs diagnosed with brain tumors was conducted. Articles published before June 2023 were identified using PubMed, Google Scholar, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science. A meta-analysis was conducted using a random-effects model through R Statistical Software. Quality was assessed using the Newcastle Ottawa Scale. Results: A total of 40 studies including 2483 patients with PBT from 21 LMICs were identified. Overall, nonspecific symptoms (62.5%) and socioeconomic status (45.0%) were the most frequently reported factors contributing to diagnostic delays. Potential sources of patient-associated delay included lack of parental awareness (45.0%) and financial constraints (42.5%). Factors contributing to health care system delays included misdiagnoses (42.5%) and improper referrals (32.5%). A pooled mean prediagnostic symptomatic interval was calculated to be 230.77 days (127.58-333.96), the patient-associated delay was 146.02 days (16.47-275.57), and the health care system delay was 225.05 days (-64.79 to 514.89). Conclusion: A multitude of factors contribute to diagnostic delays in LMICs. The disproportionate effect of these factors is demonstrated by the long interval between symptom onset and the definitive diagnosis of PBTs in LMICs, when compared with high-income countries. While evidence-based policy recommendations may improve the pace of diagnosis, policy makers will need to be cognizant of the unique challenges patients and health care systems face in LMICs. (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
Databáze:	MEDLINE
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