Diagnostic Delay Is Associated With Complicated Disease and Growth Impairment in Paediatric Crohn's Disease
Amanda Ricciuto1, David R Mack2, Hien Q Huynh3
1SickKids Hospital, University of Toronto, Toronto, ON, Canada.
Insights
Diagnostic delay in paediatric inflammatory bowel disease (IBD) increases the risk of complications like strictures and growth impairment, particularly in Crohn's disease (CD). Early diagnosis is crucial for better outcomes in children with IBD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Limited data exist on diagnostic delay's impact on pediatric inflammatory bowel disease (IBD) complications.
- Understanding this association is vital for improving pediatric IBD management.
Purpose of the Study:
- To assess the effect of diagnostic delay on IBD complications, surgery, and growth in children.
- To identify predictors of diagnostic delay in a pediatric IBD cohort.
Main Methods:
- A national, prospective, multicenter IBD inception cohort study included 1399 children.
- Diagnostic delay was defined as symptom onset to diagnosis exceeding the 75th percentile.
- Multivariable regression models analyzed associations between delay and outcomes (complications, growth, surgery).
Main Results:
- Diagnostic delay (>9.2 months) was linked to a 2.5-fold increased risk of strictures/fistulae in Crohn's disease (CD).
- Each month of delay correlated with a decrease in height-for-age z-score.
- Abdominal pain, especially isolated, predicted diagnostic delay in CD.
Conclusions:
- Diagnostic delay is a significant risk factor for stricturing/fistulizing complications and impaired growth in pediatric CD.
- Timely diagnosis is critical for mitigating severe outcomes in pediatric IBD.
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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