Clinical, Sociodemographic, and Neighborhood Factors Associated with Delayed Initial Neuroimaging in Children with Posterior Fossa Tumors
Nikhil Kumar, Clarice Ho, Tricia Morphew, Lois Sayrs, Tatiana Moreno, Pournima Navalkele, Louis Ehwerhemuepha, Aarij Gora, Behnoosh Afghani, Mariko Sato, John R CrawfordAbstract
Background
Posterior fossa tumors comprise most pediatric CNS tumors and typically present with non-specific symptoms, contributing to neuroimaging delays. This study evaluates the sociodemographic, clinical, health-system, and neighborhood risks for delayed neuroimaging.
Methods
We conducted a retrospective cohort study of 140 consecutive children with newly-diagnosed posterior fossa tumors at Children’s Hospital Orange County from 2010-2023. Demographics, clinical features, health-system factors, and neighborhood opportunity, measured by Childhood Opportunity Index (COI), were analyzed for risks of delay using hierarchical quantile and logistic regression.
Results
Among 140 children (mean age 7.0 years; 58.6% male), 60.7% underwent neuroimaging within 30 days of symptom onset; 16.4% and 22.9% experienced delays of 31–60 days and >60 days, respectively. Delays of 31–60 days were associated with headache at presentation (aOR=4.81, p = 0.012) and low health/environment COI (aOR=3.32, p = 0.039). Delays >60 days were associated with age ≥10 years (aOR=12.72, p < 0.001), ≥2 prior provider visits (aOR=11.69, p < 0.001), outpatient-ordered neuroimaging (aOR=7.28, p = 0.003), and hydrocephalus within moderate-to-high social/economic COI neighborhoods (aOR=24.97, p = 0.001). Quantile regression of the fastest neuroimaging cohort (25th-percentile) revealed that headache remained associated with a 10-day delay; and within low health/environment COI neighborhoods, Hispanic ethnicity was associated with a 20-day delay. Tumor type—low-grade glioma (35.0%), embryonal tumors (30.0%), and high-grade glioma (20.7%)—was not significantly associated with neuroimaging delays.
Conclusions
Neuroimaging delays in pediatric posterior fossa tumors were driven by older age, headache, multiple provider visits, provider-ordered imaging, and low neighborhood opportunity, particularly among Hispanic patients. These findings underscore the need for targeted interventions addressing these modifiable clinical and socioeconomic factors.