Description and study of risk factors for the diagnostic delay of paediatric inflammatory bowel disease

Arcos-Machancoses, José Vicente; Aliaga, Ester Donat; Polo-Miquel, B.; Ribes-Koninckx, Carmen; Pereda-Pérez, A.

doi:10.1016/j.anpede.2015.03.004

Cited by 11 publications

(18 citation statements)

References 27 publications

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“…As shown in Table 7, the association between age and diagnostic delay has been conflicting in adult studies, but several paediatric studies have suggested that younger children are at increased risk of diagnostic delay. 12,25,27,31 The absence of this finding in our cohort may reflect the decreasing age of IBD onset in Canada and thus greater awareness of IBD even in the youngest of children. In keeping with our findings, previous paediatric studies have suggested that symptoms other than diarrhoea are associated with diagnostic delay, 25 whereas haematochezia is protective against diagnostic delay.…”

Section: Discussionmentioning

confidence: 76%

Diagnostic Delay Is Associated With Complicated Disease and Growth Impairment in Paediatric Crohn’s Disease

Ricciuto

Mack

Huynh

et al. 2020

Journal of Crohn's and Colitis

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Background Paediatric data on the association between diagnostic delay and 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 multi-centre IBD inception cohort study, including 1399 children. Diagnostic delay was defined as time from symptom onset to diagnosis >75 th 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% CD, 36% UC/IBD-U; 57% male), median time to diagnosis was 4.2 (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-times higher rate of strictures/internal fistulae (HR 2.53, 95% CI 1.41-4.56). Every additional month of diagnostic delay was associated with a decrease in height-for-age z-score of 0.13 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.

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Section: Discussionmentioning

confidence: 76%

Diagnostic Delay Is Associated With Complicated Disease and Growth Impairment in Paediatric Crohn’s Disease

Ricciuto

Mack

Huynh

et al. 2020

Journal of Crohn's and Colitis

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“…Both of these findings are in line with those of the earlier pediatric studies by Buderus et al, Schoepfer et al, Sawczenko et al and Ricciuto et al [ 23 – 25 ]. In addition, Timmer et al [ 26 ] reported a median diagnostic delay of 4.0 months, Arcos-Machancoses et al [ 27 ] of 2.8 months and Ricciuto et al [ 8 ] of 4.2 months when considering PIBD as a whole, while Schoepfer et al [ 9 ] observed a delay of 3.0 months in CD. Interestingly, in some older studies in particular, the delays have been somewhat longer, probably reflecting the ongoing improvements in the clinical case finding and diagnostic tools of PIBD [ 28 , 29 ], although differences in the study design and methodology might also have affected.…”

Section: Discussionmentioning

confidence: 99%

“…In more detailed analysis, the time between symptom onset and referral to a specialist was the main cause of delay in both CD and UC. The few existing reports on this issue have been somewhat inconsistent [ 23 – 25 , 27 , 30 ]. In line with us, Ricciutto et al and Mouzan et al reported time before referral to account for most part of the delay in PIBD [ 25 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Ricciuto et al reported diarrhea to be associated with shorter delay and Spray et al [ 28 ] symptoms other than diarrhea with longer delay. Other factors reportedly associated with longer delay are particularly young age [ 24 , 26 , 27 , 30 ] and isolated small-bowel disease/ileal location in CD [ 25 , 26 , 29 , 30 ]. These findings are consistent with the higher risk for long delay in CD, as it often presents with vague symptoms that can be difficult for parents and physicians to recognize.…”

Section: Discussionmentioning

confidence: 99%

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Impact of diagnostic delay to the clinical presentation and associated factors in pediatric inflammatory bowel disease: a retrospective study

et al. 2021

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Background Undelayed diagnosis is thought to be a major determinant for good prognosis in pediatric inflammatory bowel disease (PIBD). However, factors predicting diagnostic delay and the consequences of this remain poorly defined. We investigated these issues in a well-defined cohort of PIBD patients. Methods Comprehensive electronic data were collected from 136 PIBD patients retrospectively. Diagnostic delay was further classified into < 6 and ≥ 6 months, and < 12 and ≥ 12 months. Logistic regression was used to calculate whether the delay was associated with clinical features and/or risk of complications and co-morbidities at diagnosis. Results The median age of patients was 12.4 years and 43.4% were females. Altogether 35.5% had Crohn´s disease (CD), 59.1% ulcerative colitis (UC) and 6.6% IBD undefined (IBD-U). The median delay before diagnosis was 5.0 months in all, 6.6 months in CD, 4.1 months in UC, and 9.8 months in IBD-U (UC vs. CD, p = 0.010). In all but IBD-U most of the delay occurred before tertiary center referral. Abdominal pain predicted a delay > 6 months in all PIBD (OR 2.07, 95% CI 1.00–4.31) and in UC patients (3.15, 1.14–8.7), while bloody stools predicted a shorter delay in all PIBD (0.28, 0.14–0.59) patients and in CD (0.10, 0.03–0.41) patients. A delay > 6 months was associated with a higher frequency of complications (2.28, 1.01–5.19). Conclusions Delay occurred mostly before specialist consultation, was longer in children presenting with abdominal pain and in CD and was associated with risk of complications. These findings emphasize the roles of active case-finding and prompt diagnostic evaluations.

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“…50% of children received their diagnosis within four months, while many studies report diagnostic delay approaching one year in CD 9,19,20 . Other registry data analyses, however, revealed comparable results with 2-4 months in the French EPIMAD study, 3 months in Spain (with a signi cant share of patients over 1 year), 4-5 months in Norway and UK and 6-10 months in the Italian registry [20][21][22][23][24] .…”

Section: Discussionmentioning

confidence: 54%

Diagnostic delay in children with inflammatory bowel disease: Results from the German-language patient registry CEDATA- GPGE 2014-2018

Leiz

Knorr

Moon

et al. 2022

Preprint

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Incidence and prevalence of pediatric onset inflammatory bowel disease (PIBD) are on the rise worldwide. Initial symptoms are often recognized with a delay, which reduces quality of life and may lead to an increased rate of complications. The aim of this study was to determine diagnostic delay in PIBD and to identify potential influencing factors. Therefore, data of the German-language patient registry CEDATA-GPGE for children and adolescents with PIBD were analyzed for the period January 2014 to December 2018. There were 456 children identified in the data, thereof 258 children (57%) with Crohn’s disease (CD) and 198 children (43%) with Ulcerative colitis (UC). The median age was 13.3 years (interquartile range (IQR) = 10.9–15.0), 44% were females. The median diagnostic delay was 4.1 months (IQR = 2.1-7.0) in CD and 2.4 months (IQR = 1.2–5.1) in UC. UC was associated with earlier diagnosis than CD (hazard ratio = 1.26; 95% CI: 1.05–1.50; p = 0.01). Only a few factors influencing the diagnostic delay have been verified. Diagnostic delay improved over the years in participating centers, but the level of awareness needs to be high even in common symptoms like abdominal pain.

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Description and study of risk factors for the diagnostic delay of paediatric inflammatory bowel disease

Cited by 11 publications

References 27 publications

Diagnostic Delay Is Associated With Complicated Disease and Growth Impairment in Paediatric Crohn’s Disease

Diagnostic Delay Is Associated With Complicated Disease and Growth Impairment in Paediatric Crohn’s Disease

Impact of diagnostic delay to the clinical presentation and associated factors in pediatric inflammatory bowel disease: a retrospective study

Diagnostic delay in children with inflammatory bowel disease: Results from the German-language patient registry CEDATA- GPGE 2014-2018

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