AI Article Synopsis
- A study of 1,399 children with inflammatory bowel disease (IBD) sought to understand how delays in diagnosis affect health outcomes, revealing a median diagnostic delay of 4.2 months, with longer delays seen in those with Crohn's disease (CD).
- Diagnostic delay was linked to a 2.5-fold increase in strictures/internal fistulae and negatively impacted growth, with each additional month of delay resulting in lower height-for-age scores.
- The findings indicate that delays in diagnosis can lead to worse complications in IBD patients, particularly in CD, and highlight the need for quicker diagnoses to improve pediatric health outcomes.
Article Abstract
Background: Paediatric data on the association between diagnostic delay and inflammatory bowel disease [IBD] complications are lacking. We aimed to determine the effect of diagnostic delay on stricturing/fistulising complications, surgery, and growth impairment in a large paediatric cohort, and to identify predictors of diagnostic delay.
Methods: We conducted a national, prospective, multicentre IBD inception cohort study including 1399 children. Diagnostic delay was defined as time from symptom onset to diagnosis >75th percentile. Multivariable proportional hazards [PH] regression was used to examine the association between diagnostic delay and stricturing/fistulising complications and surgery, and multivariable linear regression to examine the association between diagnostic delay and growth. Predictors of diagnostic delay were identified using Cox PH regression.
Results: Overall (64% Crohn's disease [CD]; 36% ulcerative colitis/IBD unclassified [UC/IBD-U]; 57% male]), median time to diagnosis was 4.2 (interquartile range [IQR] 2.0-9.2) months. For the overall cohort, diagnostic delay was >9.2 months; in CD, >10.8 months and in UC/IBD-U, >6.6 months. In CD, diagnostic delay was associated with a 2.5-fold higher rate of strictures/internal fistulae (hazard ratio [HR] 2.53, 95% confidence interval [CI] 1.41-4.56). Every additional month of diagnostic delay was associated with a decrease in height-for-age z-score of 0.013 standard deviations [95% CI 0.005-0.021]. Associations persisted after adjusting for disease location and therapy. No independent association was observed between diagnostic delay and surgery in CD or UC/IBD-U. Diagnostic delay was more common in CD, particularly small bowel CD. Abdominal pain, including isolated abdominal pain in CD, was associated with diagnostic delay.
Conclusions: Diagnostic delay represents a risk factor for stricturing/internal fistulising complications and growth impairment in paediatric CD.
Podcast: This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944510 | PMC |
| http://dx.doi.org/10.1093/ecco-jcc/jjaa197 | DOI Listing |
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