Related Experiment Video
Updated: Jul 2, 2025
DNBS/TNBS Colitis Models: Providing Insights Into Inflammatory Bowel Disease and Effects of Dietary Fat
Published on: February 27, 2014
Variation in the Care of Children with Inflammatory Bowel Disease Within and Across Canadian Provinces: A
M Ellen Kuenzig1,2, Therese A Stukel3,4, Matthew W Carroll5
1SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada.
Insights
Childhood inflammatory bowel disease (IBD) care varies significantly across Canadian pediatric centers. Early emergency department (ED) visits at diagnosis correlate with higher hospitalizations and surgeries for Crohn's disease, highlighting a need for improved care pathways.
Area of Science:
- Pediatric Gastroenterology
- Health Services Research
- Clinical Epidemiology
Background:
- The incidence of childhood-onset inflammatory bowel disease (IBD) is increasing globally.
- Significant variations in healthcare utilization and surgical needs exist among pediatric IBD patients.
Purpose of the Study:
- To describe variations in health services utilization and surgical needs for pediatric IBD patients (6-60 months post-diagnosis) across Canadian centers.
- To evaluate associations between initial diagnostic care and subsequent health outcomes.
Main Methods:
- Utilized population-based, linked health administrative data from four Canadian provinces.
- Identified pediatric IBD cases (<16 years) using validated algorithms and assigned centers of care.
- Employed mixed-effects meta-analysis to assess outcomes (hospitalizations, ED visits, surgery) and care provision associations.
Main Results:
- Identified 3784 incident pediatric IBD cases; 77.6% treated at pediatric centers.
- High rates of IBD-related hospitalizations (31.4% of children) and emergency department (ED) visits (55.8%) were observed.
- Centers with higher initial ED utilization showed increased hospitalizations and ED visits; high heterogeneity in Crohn's disease intestinal resection rates was noted, but not for ulcerative colitis colectomy.
Conclusions:
- Significant variation exists in health services utilization and surgical risk (Crohn's disease intestinal resection) among pediatric IBD patients across Canadian centers.
- Improvements in clinical care pathways are essential for equitable, timely, and high-quality care for all children with IBD.
Purpose:
The incidence of childhood-onset inflammatory bowel disease (IBD) is rising. We described variation in health services utilization and need for surgery among children with IBD between six and 60 months following IBD diagnosis across Canadian pediatric centers and evaluated the associations between care provided at diagnosis at each center and the variation in these outcomes.
Patients And Methods:
Using population-based deterministically-linked health administrative data from four Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario) we identified children diagnosed with IBD <16 years of age using validated algorithms. Children were assigned to a pediatric center of care using a hierarchical approach based on where they received their initial care. Outcomes included IBD-related hospitalizations, emergency department (ED) visits, and IBD-related abdominal surgery occurring between 6 and sixty months after diagnosis. Mixed-effects meta-analysis was used to pool results and examine the association between center-level care provision and outcomes.
Results:
We identified 3784 incident cases of pediatric IBD, of whom 2937 (77.6%) were treated at pediatric centers. Almost a third (31.4%) of children had ≥1 IBD-related hospitalization and there were 0.66 hospitalizations per person during follow-up. More than half (55.8%) of children had ≥1 ED visit and there were 1.64 ED visits per person. Between-center heterogeneity was high for both outcomes; centers where more children visited the ED at diagnosis had more IBD-related hospitalizations and more ED visits during follow-up. Between-center heterogeneity was high for intestinal resection in Crohn's disease but not colectomy in ulcerative colitis.
Conclusion:
There is variation in health services utilization among children with IBD and risk of undergoing intestinal resection in those with Crohn's disease, but not colectomy among children with ulcerative colitis, across Canadian pediatric tertiary-care centers. Improvements in clinical care pathways are needed to ensure all children have equitable and timely access to high quality care.
Related Concept Videos
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD: