DEI-02. Delayed neuroimaging in newly diagnosed pediatric posterior fossa tumors: The Children’s Hospital of Orange County experience

Abstract Our study aims to understand the impact of social determinants of health, demographic, and clinical characteristics on delayed initial neuroimaging of posterior fossa brain tumors. A retrospective chart review was performed for 140 patients ages 0-17 (59% male, 44% Hispanic; mean age 7.0 ± 4.7 years) with newly diagnosed posterior fossa tumors (68% cerebellar, 32% brainstem, 35% low grade glioma, 69% associated hydrocephalus) at Children’s Hospital Orange County from February 2010 to May 2023. Time to diagnostic neuroimaging from initial symptom onset along with socio-demographic factors (measured by the Child Opportunity Index COI v3.0) were analyzed. Patients were divided into three groups based on time to initial neuroimaging: 30 days, 30 days (delayed), and 90 days (extremely delayed). Sixty-one percent of patients underwent initial imaging within 30 days, while 26.4% and 12.9% of patients experienced delay of 31-90 days and 90 days, respectively. Patients ≥10 years of age were 3.6 times more likely to have experienced delay (OR: 3.6 1.67-7.81 p=.001), and 4 times more likely to have experienced extreme delay compared to younger patients (OR: 4.0 1.45-11.10 p = 0.008). COI, gender, race, ethnicity, and insurance type were not associated with delayed neuroimaging. Patients with very low to low COI scores in education and health/environment domains were 3.7 times (OR: 3.7 1.34-9.90 p=.011) and 3 times (OR: 3.0 1.3-6.95 p = 0.01) more likely, respectively, to have experienced delayed neuroimaging greater than 30 days. Neuroimaging ordered by outpatient primary providers demonstrated two-fold delay of 30 days (p = 0.03) and a three-fold delay of 90 days (p = 0.03) Delayed neuroimaging was more common in older children and those residing in neighborhoods with lower educational and health opportunities, emphasizing the need for targeted educational and clinical initiatives for both providers and patients to address barriers leading to delayed diagnosis of posterior fossa tumors.