Time to diagnosis in paediatric inflammatory bowel disease: Key points for an early diagnosis

Martín-de-Carpi, Javier; Treviño, Santiago Jiménez; Muncunill, Gemma Pujol; Martín-Masot, Rafael; Navas-López, Víctor Manuel

doi:10.1016/j.anpede.2019.11.004

Cited by 5 publications

(8 citation statements)

References 32 publications

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“…Perhaps, the most successful approach in these situations is to know the periods of usual evolution of the different diagnosed entities and transmit this to families and, in case the symptoms persist beyond the established period, start the differential diagnosis ( 4 ). It is worth noting the high number of MODs in our series, an aspect that has not been assessed or quantified in other published series ( 4 ). MODs are instances in which post-hoc judgment indicates that alternative decisions or actions could have led to a more timely diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Medical care episodes were defined as those situations of doctor–patient interaction either in primary care, emergency care departments (ERs), or hospital care ( 4 ). The exact dates of the onset of symptoms and the initial consultation and the type of physician were collected, as well as the number of visits to the same physician before being referred to the PG, number of physicians consulted until reaching an IBD diagnosis, number of visits to the ER and hospital admissions generated before the diagnosis, date of referral to the PG, date of the first visit to the PG, date of the endoscopic procedures, and the date of IBD diagnosis if they were not the same.…”

Section: Methodsmentioning

confidence: 99%

“…To consider the time of onset of symptoms, the following were considered signs or symptoms suggestive of IBD ( 4 ):…”

Section: Methodsmentioning

confidence: 99%

“…), which it should be noted, account for a high number of visits they must face daily. These three factors, low prevalence of PIBD, attention to more prevalent diseases, and heavy caseloads, might condition a lack of diagnostic suspicion and, therefore, a delay in the diagnosis of inflammatory bowel disease (IBD) ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…Time to diagnosis (TD) is defined as the time interval from the patient's onset of symptoms to the final diagnosis of IBD ( 5 ) and is especially relevant in children. Missing school days and social isolation secondary to the disease and the undue prolongation of the diagnostic process are some of the potential consequences of prolonged TD ( 4 ). Diagnosis delay (DD) in PIBD is associated with an increased risk of complications ( 6 , 7 ), growth failure and delayed puberty ( 8 ), more extensive disease ( 3 , 9 , 10 ), worse response to medical treatment ( 9 ), greater need for surgery ( 6 ), and lower health-related quality of life ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Spanish Pediatric Inflammatory Bowel Disease Diagnostic Delay Registry: SPIDER Study From Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica

et al. 2020

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Background and Aims: Diagnostic delay (DD) is especially relevant in children with inflammatory bowel disease, leading to potential complications. We examined the intervals and factors for DD in the pediatric population of Spain. Methods: We conducted a multicentric prospective study, including 149 pediatric inflammatory bowel disease patients, obtaining clinical, anthropometric, and biochemical data. Time to diagnosis (TD) was divided into several intervals to identify those where the Jiménez Treviño et al. Pediatric IBD Diagnostic Delay in Spain DD was longer and find the variables that prolonged those intervals. Missed opportunities for diagnosis (MODs) were also identified. Results: Overall TD was 4.4 months (interquartile range [IQR] 2.6-10.4), being significantly higher in Crohn's disease (CD) than in ulcerative colitis (UC) (6.3 [IQR 3.3-12.3] vs. 3 [IQR 1.6-5.6] months, p = 0.0001). Time from the visit to the first physician until referral to a pediatric gastroenterologist was the main contributor to TD (2.4 months [IQR 1.03-7.17] in CD vs. 0.83 months [IQR 0.30-2.50] in UC, p = 0.0001). One hundred and ten patients (78.3%) visited more than one physician (29.9% to 4 or more), and 16.3% visited the same physician more than six times before being assessed by the pediatric gastroenterologist. The number of MODs was significantly higher in CD than that in UC patients: 4 MODs (IQR 2-7) vs. 2 MODs ([IQR 1-5], p = 0.003). Referral by pediatricians from hospital care allowed earlier IBD diagnosis (odds ratio 3.2 [95% confidence interval 1.1-8.9], p = 0.025). Conclusions: TD and DD were significantly higher in CD than those in UC. IBD patients (especially those with CD) undergo a large number of medical visits until the final diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…To consider the time of onset of symptoms, the following were considered signs or symptoms suggestive of IBD ( 4 ):…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Spanish Pediatric Inflammatory Bowel Disease Diagnostic Delay Registry: SPIDER Study From Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica

et al. 2020

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Racial and ethnic differences in diagnosis age and blood biomarkers in a pediatric inflammatory bowel disease cohort

Kemp,

Nagaraj,

Orihuela

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivePrompt diagnosis of pediatric‐onset inflammatory bowel disease (IBD) is crucial for preventing a complicated disease course; however, it is not well understood how social determinants of health might affect pediatric IBD diagnosis. This study examined differences in diagnosis age, biomarkers of disease severity, and anthropometrics with sociodemographic factors in a pediatric IBD cohort.MethodsPediatric IBD patients (n = 114) and their parents/caregivers were enrolled from the Children's of Alabama Pediatric IBD Clinic in Birmingham, Alabama. Primary analyses examined associations of child race and ethnicity, parental income, parental education, single‐parent household status, insurance type, and distance to a tertiary pediatric gastroenterology referral center with diagnosis age. Secondary analyses examined differences in biomarker levels, height, and body mass index at the time of diagnosis.ResultsRacial and ethnic minority children were diagnosed at an older age compared to Non‐Hispanic White children (14.4 ± 0.40 vs. 11.7 ± 0.38 years; p < 0.001), and this trend was robust to adjustment with other sociodemographic variables. Parental attainment of a college education attenuated the link between minority race and ethnicity and the likelihood of older age at diagnosis, while other sociodemographic variables had no moderating effect. Racial and ethnic minority children were 5.7 times more likely to have clinically elevated erythrocyte sedimentation rate at diagnosis compared to Non‐Hispanic White children (p = .024).ConclusionsThese results suggest that child race and ethnicity may exert a primary effect on the age at diagnosis with pediatric‐onset IBD. This study highlights the need for further research on racial and ethnic disparities to promote health equity in pediatric‐onset IBD.

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Inflammatory bowel disease's association with growth retardation even before presenting digestive symptoms

Martín-Masot¹,

Navas-López²

2022

Minerva Pediatr

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Time to diagnosis in paediatric inflammatory bowel disease: Key points for an early diagnosis

Cited by 5 publications

References 32 publications

Spanish Pediatric Inflammatory Bowel Disease Diagnostic Delay Registry: SPIDER Study From Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica

Spanish Pediatric Inflammatory Bowel Disease Diagnostic Delay Registry: SPIDER Study From Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica

Racial and ethnic differences in diagnosis age and blood biomarkers in a pediatric inflammatory bowel disease cohort

Inflammatory bowel disease's association with growth retardation even before presenting digestive symptoms

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