Musculoskeletal misdiagnoses in pediatric patients with spinal tumors

Aurora Dybedokken; Rene Mathiesen; Henrik Hasle; Troels Herlin; Michael Thude Callesen; Søren Holm Hansen; Laura Hallundbæk Jensen; Jesper Amstrup; Søren Hagstrøm; Ninna Brix

doi:10.1002/pbc.31024

Musculoskeletal misdiagnoses in pediatric patients with spinal tumors

Aurora Dybedokken, Rene Mathiesen, Henrik Hasle, Troels Herlin, Michael Thude Callesen, Søren Holm Hansen, Laura Hallundbæk Jensen, Jesper Amstrup, Søren Hagstrøm, Ninna Brix^*

^*Corresponding author for this work

Department of Clinical Medicine - Department of Paediatrics

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

1 Citation (Scopus)

Abstract

Objective: Childhood spinal tumors often present with musculoskeletal symptoms, potentially causing a misdiagnosis and delays in diagnosis and treatment. This study aims to identify, characterize, and compare children with spinal tumors who had prior musculoskeletal misdiagnoses to those without, analyzing clinical presentation, diagnostic interval, and outcome. Study design: This retrospective cohort study evaluated all children aged 0–14 years diagnosed with a spinal tumor in Denmark from 1996 to 2018. The cohort was identified through the Danish Childhood Cancer Registry, and the registry data were supplemented with data from medical records. The survival was compared using the Kaplan–Meier method. Results: Among 58 patients, 57% (33/58) received musculoskeletal misdiagnoses before the spinal tumor diagnosis. Misdiagnoses were mostly nonspecific (64%, 21/33), involving pain and accidental lesions, while 36% (12/33) were rheumatologic diagnoses. The patients with prior misdiagnosis had less aggressive tumors, fewer neurological/general symptoms, and 5.5 months median diagnostic interval versus 3 months for those without a misdiagnosis. Those with prior misdiagnoses tended to have a higher 5-year survival of 83% (95% confidence interval [CI]: 63%–92%) compared to 66% (95% CI: 44%–82%) for those without (p =.15). Conclusion: Less aggressive spinal tumors may manifest as gradual skeletal abnormalities and musculoskeletal symptoms without neurological/general symptoms, leading to misdiagnoses and delays.

Original language	English
Article number	e31024
Journal	Pediatric Blood and Cancer
Volume	71
Issue	7
ISSN	1545-5009
DOIs	https://doi.org/10.1002/pbc.31024
Publication status	Published - Jul 2024

Keywords

child
CNS tumors
diagnostic interval
misdiagnosis
musculoskeletal symptoms
pediatric
spinal tumors

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title = "Musculoskeletal misdiagnoses in pediatric patients with spinal tumors",

abstract = "Objective: Childhood spinal tumors often present with musculoskeletal symptoms, potentially causing a misdiagnosis and delays in diagnosis and treatment. This study aims to identify, characterize, and compare children with spinal tumors who had prior musculoskeletal misdiagnoses to those without, analyzing clinical presentation, diagnostic interval, and outcome. Study design: This retrospective cohort study evaluated all children aged 0–14 years diagnosed with a spinal tumor in Denmark from 1996 to 2018. The cohort was identified through the Danish Childhood Cancer Registry, and the registry data were supplemented with data from medical records. The survival was compared using the Kaplan–Meier method. Results: Among 58 patients, 57\% (33/58) received musculoskeletal misdiagnoses before the spinal tumor diagnosis. Misdiagnoses were mostly nonspecific (64\%, 21/33), involving pain and accidental lesions, while 36\% (12/33) were rheumatologic diagnoses. The patients with prior misdiagnosis had less aggressive tumors, fewer neurological/general symptoms, and 5.5 months median diagnostic interval versus 3 months for those without a misdiagnosis. Those with prior misdiagnoses tended to have a higher 5-year survival of 83\% (95\% confidence interval [CI]: 63\%–92\%) compared to 66\% (95\% CI: 44\%–82\%) for those without (p =.15). Conclusion: Less aggressive spinal tumors may manifest as gradual skeletal abnormalities and musculoskeletal symptoms without neurological/general symptoms, leading to misdiagnoses and delays.",

keywords = "child, CNS tumors, diagnostic interval, misdiagnosis, musculoskeletal symptoms, pediatric, spinal tumors",

author = "Aurora Dybedokken and Rene Mathiesen and Henrik Hasle and Troels Herlin and Callesen, \{Michael Thude\} and Hansen, \{S{\o}ren Holm\} and Jensen, \{Laura Hallundb{\ae}k\} and Jesper Amstrup and S{\o}ren Hagstr{\o}m and Ninna Brix",

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T1 - Musculoskeletal misdiagnoses in pediatric patients with spinal tumors

AU - Dybedokken, Aurora

AU - Mathiesen, Rene

AU - Hasle, Henrik

AU - Herlin, Troels

AU - Callesen, Michael Thude

AU - Hansen, Søren Holm

AU - Jensen, Laura Hallundbæk

AU - Amstrup, Jesper

AU - Hagstrøm, Søren

AU - Brix, Ninna

PY - 2024/7

Y1 - 2024/7

N2 - Objective: Childhood spinal tumors often present with musculoskeletal symptoms, potentially causing a misdiagnosis and delays in diagnosis and treatment. This study aims to identify, characterize, and compare children with spinal tumors who had prior musculoskeletal misdiagnoses to those without, analyzing clinical presentation, diagnostic interval, and outcome. Study design: This retrospective cohort study evaluated all children aged 0–14 years diagnosed with a spinal tumor in Denmark from 1996 to 2018. The cohort was identified through the Danish Childhood Cancer Registry, and the registry data were supplemented with data from medical records. The survival was compared using the Kaplan–Meier method. Results: Among 58 patients, 57% (33/58) received musculoskeletal misdiagnoses before the spinal tumor diagnosis. Misdiagnoses were mostly nonspecific (64%, 21/33), involving pain and accidental lesions, while 36% (12/33) were rheumatologic diagnoses. The patients with prior misdiagnosis had less aggressive tumors, fewer neurological/general symptoms, and 5.5 months median diagnostic interval versus 3 months for those without a misdiagnosis. Those with prior misdiagnoses tended to have a higher 5-year survival of 83% (95% confidence interval [CI]: 63%–92%) compared to 66% (95% CI: 44%–82%) for those without (p =.15). Conclusion: Less aggressive spinal tumors may manifest as gradual skeletal abnormalities and musculoskeletal symptoms without neurological/general symptoms, leading to misdiagnoses and delays.

AB - Objective: Childhood spinal tumors often present with musculoskeletal symptoms, potentially causing a misdiagnosis and delays in diagnosis and treatment. This study aims to identify, characterize, and compare children with spinal tumors who had prior musculoskeletal misdiagnoses to those without, analyzing clinical presentation, diagnostic interval, and outcome. Study design: This retrospective cohort study evaluated all children aged 0–14 years diagnosed with a spinal tumor in Denmark from 1996 to 2018. The cohort was identified through the Danish Childhood Cancer Registry, and the registry data were supplemented with data from medical records. The survival was compared using the Kaplan–Meier method. Results: Among 58 patients, 57% (33/58) received musculoskeletal misdiagnoses before the spinal tumor diagnosis. Misdiagnoses were mostly nonspecific (64%, 21/33), involving pain and accidental lesions, while 36% (12/33) were rheumatologic diagnoses. The patients with prior misdiagnosis had less aggressive tumors, fewer neurological/general symptoms, and 5.5 months median diagnostic interval versus 3 months for those without a misdiagnosis. Those with prior misdiagnoses tended to have a higher 5-year survival of 83% (95% confidence interval [CI]: 63%–92%) compared to 66% (95% CI: 44%–82%) for those without (p =.15). Conclusion: Less aggressive spinal tumors may manifest as gradual skeletal abnormalities and musculoskeletal symptoms without neurological/general symptoms, leading to misdiagnoses and delays.

KW - child

KW - CNS tumors

KW - diagnostic interval

KW - misdiagnosis

KW - musculoskeletal symptoms

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KW - spinal tumors

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JO - Pediatric Blood and Cancer

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Musculoskeletal misdiagnoses in pediatric patients with spinal tumors

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Keywords

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