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EVOLUTION OF DIAGNOSTIC DELAY IN PEDIATRIC INFLAMMATORY BOWEL DISEASE AND THE IMPACT OF THE COVID-19 PANDEMIC
Ana Rute Manuel1, Tiago Magalhães2,3, Maria Cristina Granado4
1Pediatrics Department, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal.
Insights
Diagnostic delay in pediatric inflammatory bowel disease (IBD) remains a significant challenge, showing no improvement over recent years. Strategies to improve early recognition and referral are crucial for better patient outcomes.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Diagnostic Medicine
Background:
- Pediatric inflammatory bowel disease (IBD) diagnosis is increasingly complex.
- Diagnostic delays negatively impact young patients.
- Understanding diagnostic timelines is critical for improving care.
Purpose of the Study:
- To analyze trends in diagnostic delay for pediatric IBD.
- To assess the impact of the COVID-19 pandemic on diagnostic timelines.
- To identify key factors contributing to diagnostic delay.
Main Methods:
- Retrospective analysis of pediatric IBD patients diagnosed in 2014, 2019, and 2020.
- Calculation and comparison of diagnostic delay, time to first medical visit, time to pediatric gastroenterologist (PG) visit, and time to diagnosis.
- Statistical comparison between pre-pandemic (2014 vs. 2019) and pandemic (2019 vs. 2020) periods.
Main Results:
- No significant changes in overall diagnostic delay were observed between 2014, 2019, and 2020.
- Time to first visit for ulcerative colitis (UC) and Undetermined-IBD initially increased in 2019 but decreased in 2020.
- Diagnostic delay was longer for Crohn's disease (CD) compared to UC and Undetermined-IBD.
Conclusions:
- Diagnostic delay in pediatric IBD has not significantly improved in recent years.
- Time to pediatric gastroenterologist (PG) consultation and overall diagnosis time are critical factors in delay.
- Enhancing symptom recognition in primary care and streamlining referrals are essential.
- The COVID-19 pandemic did not impair pediatric IBD diagnosis timelines at this center.
Background:
Pediatric inflammatory bowel disease (IBD) is increasingly prevalent, but diagnosis can still be challenging. Diagnostic delay is particularly deleterious in this age group.
Objective:
This study explores the evolution of diagnostic delay in pediatric IBD and the influence of the COVID-19 pandemic.
Methods:
Retrospective study including all pediatric IBD patients diagnosed during 2014, 2019 and 2020 in a tertiary hospital. Diagnostic delay, time to first medical visit, time to pediatric gastroenterologist (PG) visit and time to diagnosis were calculated and compared within a gap of five years (2019 and 2014) and with the year of onset of the pandemic (2020 and 2019).
Results:
A total of 93 participants were included (2014: 32, 2019: 30, 2020: 31). No significant differences were observed in diagnostic delay, time to first medical visit in Crohn's disease (CD), time to PG visit and time to diagnosis when comparing 2019-2014 and 2020-2019. Time to first visit in ulcerative colitis (UC) and Undetermined-IBD increased in 2019 (P=0.03), with new decrease in 2020 (P=0.04). Diagnostic delay was longer in DC compared to UC plus Undetermined-IBD.
Conclusion:
Diagnostic delay is still an important matter in pediatric IBD, with no significant change over the last years. The time to the first PG visit and the time for diagnosis seem to have the greatest impact on diagnostic delay. Thus, strategies to enhance recognition of IBD symptoms among first-line physicians and to improve communication, facilitating referral, are of utmost importance. Despite the restraints in the health care system caused by the pandemic, time to diagnosis in pediatric IBD was not impaired during 2020 in our center.
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