Ricciuto A, et al. – The specialists undertook this study to evaluate time to diagnosis in children inflammatory bowel disease (IBD) as well as to analyze factors associated with diagnostic delay. They discovered that diagnostic delay was more common in Crohn’s disease (CD) and associated with height impairment that persisted 1 year after presentation. It was found that the greatest contributor to time to diagnosis was the time from symptom onset to referral.

Methods

• This study consisted of children with incident IBD at the Hospital for Sick Children diagnosed between December 2013 and December 2015.
• Time to diagnosis and its subintervals were determined and patient, disease and institutional factors were tested for associations.

Results

• This study enrolled 111 children.
• 4.5 (IQR 2.1–8.8) months was the median overall time to diagnosis.
• Findings revealed that time to diagnosis was longer in Crohn’s disease (CD) than ulcerative colitis (UC) (median 6.8 (IQR 2.9–12.5) vs 2.4 (IQR 1.3–5.3) months) and patients with isolated small bowel disease.
• 20% of patients were diagnosed ≥1 year after symptom onset (86% CD, 14% UC, p=0.003).
• Time from symptom onset to gastroenterology referral was the greatest contributor to overall time to diagnosis (median 2.9 (IQR 1.6–8.2) months).
• Height impairment was independently associated with diagnostic delay (OR 0.59, p=0.02, for height–for–age z–score (HAZ), signifying almost 70% increased odds of delay for every 1 SD decrease in HAZ).
• This height discrepancy persisted 1 year after diagnosis.
• Bloody diarrhoea was protective against delay (OR 0.28, p=0.02).
• The subinterval from referral to diagnosis was shorter in patients with laboratory abnormalities, particularly hypoalbuminaemia.