Aims and Objectives Brain tumours are the commonest paediatric solid tumour [1]. Presenting symptoms are often non-specific, posing diagnostic challenges in the Children’s Emergency Department (CED). We aimed to establish practice at a tertiary CED regarding radiological investigation for children with suspected malignant space occupying lesions (SOL), and assess whether practice may under- or over-investigate paediatric presentations.(2)(3).

Method and Design A retrospective cohort study of patients aged 0-15 undergoing CT imaging in CED for suspected SOLs between April 2022-2024. Demographic, clinical and diagnostic data were collected and assessed against ‘HeadSmart’ imaging recommendations SOL detection. Scans focussed on other pathologies (abscesses/trauma/shunts or existing pathologies) were excluded.

Results and Conclusion 304 patients were included. In patients ≤4yrs (n=95), 92% of scans were ordered in line with HeadSmart criteria. One SOL was reported (NNT = 95).

In the >5yr group (n=209), 83% of scans were requested in line with guidelines. >50% of scans were prompted by headaches. Of those not meeting imaging criteria (n=35), 92% had symptoms of insufficient duration. Four neoplastic SOLs were diagnosed (NNT=52).

All confirmed new SOL diagnoses met imaging criteria.

26.6% (n=81) of patients subsequently underwent an MRI. In those with a normal CT head (n=58), the pick-up of benign findings was 15.5% (n=9), with no additional SOLs identified.

Whilst most CT heads for suspected SOL were ordered appropriately, there were numerous >5yrs who did not meet national criteria. However, there may be an opportunity for non-radiological reassurance (clinical evaluation, observations and fundoscopy) with careful safety-netting and timely follow-up in these selected patients. MRI imaging did not increase SOL discovery following normal CT and may be unnecessary unless significant concerns remain. Whilst national guidelines support effective SOL detection in CED, a balance needs to be struck to limit unnecessary radiation and MRI use.