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Systematic Review of Diagnostic Delay for Children With Inflammatory Bowel Disease
Angharad Vernon-Roberts1, Kristina Aluzaite2, Bahareh Khalilipour2
1From the Department of Pediatrics, University of Otago, Christchurch, New Zealand.
Insights
Diagnostic delay in pediatric inflammatory bowel disease (IBD) averaged 4.5 months overall, with Crohn's disease (CD) taking longer than ulcerative colitis (UC). This data helps benchmark delays and identify areas for improvement in pediatric IBD care.
Area of Science:
- Gastroenterology
- Pediatric Medicine
- Inflammatory Bowel Disease Research
Background:
- Pediatric inflammatory bowel disease (IBD) is a complex gut condition requiring timely diagnosis.
- Diagnostic delay (DD) in children with IBD refers to prolonged periods from symptom onset to confirmed diagnosis.
- Understanding factors contributing to DD is crucial for improving pediatric IBD management.
Purpose of the Study:
- To systematically review and synthesize existing data on diagnostic delay (DD) in pediatric inflammatory bowel disease (IBD).
- To identify and analyze factors associated with prolonged DD in children diagnosed with IBD.
- To provide a benchmark for DD in pediatric IBD for healthcare providers and researchers.
Main Methods:
- A comprehensive literature search was conducted across six health databases up to December 2020.
- Inclusion criteria focused on studies of children (<18 years) with IBD, reporting central tendency data for DD, and cohorts exceeding 10 patients.
- Data from 26 eligible studies, encompassing 7030 children, were analyzed, with weighting by cohort sample size.
Main Results:
- The overall pooled diagnostic delay (DD) for pediatric inflammatory bowel disease (IBD) was 4.5 months.
- Crohn's disease (CD) exhibited a longer DD (5 months) compared to ulcerative colitis/indeterminate colitis/IBD-unclassified (UC/IC/IBDU) (3 months).
- Diagnostic delay has decreased over time for IBD and UC, but a trend towards an increase was observed for CD.
Conclusions:
- The findings establish a benchmark for diagnostic delay (DD) in pediatric inflammatory bowel disease (IBD), aiding in performance evaluation.
- Healthcare centers can utilize this data to assess and potentially reduce DD through enhanced awareness or infrastructure improvements.
- Minimizing diagnostic delay is essential for mitigating the risk of adverse outcomes in children with IBD.
Objectives:
Pediatric inflammatory bowel disease (IBD) is a complex inflammatory condition of the gut. Diagnosing IBD involves distinct longitudinal periods from first symptoms to primary care assessment, tertiary care referral, and then endoscopic confirmation. The term diagnostic delay (DD) is used if these periods are prolonged. The aim of this review was to amalgamate DD data for children with IBD, and identify factors associated with prolonged DD.
Methods:
Six health literature databases were searched (December 2020). Inclusion criteria for papers were children diagnosed with IBD before the age of 18 years, DD central tendency data, and to report a central tendency of their DD data, cohort >10 children. For analysis, all data were weighted by cohort sample size.
Results:
Searches identified 236 papers, and 26 were included in the final analysis with a pooled cohort of 7030 children. The overall DD periods were IBD 4.5 months [Interquartile range (IQR) 3.6-8.7 months], Crohn disease (CD) 5 months (IQR 4-7.2 months), and ulcerative colitis/indeterminate colitis/IBD-unclassified (UC/IC/IBDU) 3 months (IQR 2.2-4.9 months). The difference between subtypes was significant ( P < 0.001), with shorter DD for UC/IC/IBDU than CD ( P < 0.001) and IBD ( P < 0.001). DD periods were longer for CD than IBD ( P < 0.001). DD decreased over time for IBD ( P < 0.001) and UC ( P < 0.001) but the trend suggested an increase for CD ( P 0.069).
Conclusions:
This data can be used to benchmark DD for children with IBD. Individual centers could determine whether improvements to awareness or infrastructure may reduce DD in order to minimize the risk of poor outcomes.
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