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[Description and study of risk factors for the diagnostic delay of pediatric inflammatory bowel disease]
J V Arcos-Machancoses1, E Donat-Aliaga1, B Polo-Miquel1
1Unidad de Gastroenterología y Hepatología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España.
Insights
Diagnostic delays in pediatric inflammatory bowel disease (IBD) are common, with a significant percentage of children experiencing delays over a year. While the median delay is 12 weeks, further investigation into missed diagnostic opportunities is crucial for improving outcomes.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Diagnostic Timeliness
Background:
- Diagnostic delay in pediatric inflammatory bowel disease (IBD) can lead to complications and reduced treatment efficacy.
- Understanding diagnostic delay factors is essential for implementing improvements and enhancing patient prognosis.
Purpose of the Study:
- To evaluate the diagnostic delay in pediatric inflammatory bowel disease (IBD).
- To identify factors contributing to diagnostic delays in children with IBD.
Main Methods:
- Retrospective analysis of 53 pediatric IBD patients' medical records (2000-2012).
- Data collected from primary care and a tertiary hospital's pediatric gastroenterology service.
- Primary outcome measured: time from initial physician contact to diagnosis.
Main Results:
- Median diagnostic delay for pediatric IBD was 12 weeks.
- Over 25% of Crohn's disease and ulcerative colitis cases exceeded a 1-year diagnostic interval.
- No specific risk factors were significantly associated with delay, though younger children trended towards longer delays.
Conclusions:
- While the median diagnostic delay for pediatric IBD may appear acceptable, a substantial proportion of children face considerable delays.
- Heterogeneous clinical presentations in pediatric IBD contribute to diagnostic challenges.
- Further research is warranted to identify and address "lost diagnostic opportunities" to improve timely diagnosis and management.
Introduction:
Diagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment. The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease.
Patients And Methods:
A retrospective study of the information collected from primary care medical records and that from the pediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out on 53 patients: 31 with Crohn's disease, 19 with ulcerative colitis, and 3 with unclassified pediatric inflammatory bowel disease. The main response variable was the interval from the first physician-patient contact to diagnosis.
Results:
The median time to diagnosis was 12 weeks (interquartile range 5-24). However for 26.3% of the ulcerative colitis cases and 25.8% of the Crohn's disease cases, the interval was longer than 1 year. There was a more marked delay trend in Crohn's disease cases, but it was not statistically significant. None of the evaluated risk factors was associated with a relevant diagnostic delay, although it tended to be longer in younger children.
Conclusions:
Whereas the median delay for pediatric inflammatory bowel disease seems to be acceptable, the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics. Further research into lost diagnostic opportunities needs to be carried out.
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