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Diagnostic delay in Canadian children with inflammatory bowel disease is more common in Crohn’s disease and associated with decreased height
  1. Amanda Ricciuto,
  2. Jennifer R Fish,
  3. Diane E Tomalty,
  4. Nicholas Carman,
  5. Eileen Crowley,
  6. Cynthia Popalis,
  7. Aleixo Muise,
  8. Thomas D Walters,
  9. Anne M Griffiths,
  10. Peter C Church
  1. Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Dr Peter C Church, Division of Gastroenterology, Hepatology and Nutrition Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; peter.church{at}sickkids.ca

Abstract

Objectives To determine time to diagnosis in a paediatric inflammatory bowel disease (IBD) cohort and the relative contribution of the component intervals, and to identify factors associated with diagnostic delay.

Design Prospective cohort study

Setting Single-centre study including children with incident IBD at the Hospital for Sick Children diagnosed between December 2013 and December 2015.

Interventions Time to diagnosis and its subintervals were determined and patient, disease and institutional factors were tested for associations.

Results Among 111 children, the median overall time to diagnosis was 4.5 (IQR 2.1–8.8) months. 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. Twenty per cent 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.

Conclusions Diagnostic delay was more common in CD and associated with height impairment that persisted 1 year after presentation. The greatest contributor to time to diagnosis was time from symptom onset to referral.

  • gastroenterology
  • general paediatrics
  • growth

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Footnotes

  • Contributors AR: Study design; data collection; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript. JF: Data collection; critical revision of the manuscript. DET: Data collection; critical revision of the manuscript. NC: Data collection; critical revision of the manuscript. EC: Data collection; critical revision of the manuscript. CP: Data collection; critical revision of the manuscript. AM: Data collection; critical revision of the manuscript. TDW: Data collection; interpretation of data; critical revision of the manuscript. AMG: Data collection; interpretation of data; critical revision of the manuscript. PCC: Study concept and design; data collection; analysis and interpretation of data; critical revision of the manuscript.

  • Funding The Canadian Children IBD Network inception cohort study is funded by CH.I.L.D Foundation andCIHR.

  • Competing interests None declared.

  • Ethics approval Hospital for Sick Children Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All study data are available for sharing to investigators of the CIDsCaNN network (Canadian paediatric IBD network) through Red Cap. The participating CIDsCaNN sites include: BC Children’s Hospital, Alberta Children’s Hospital, Stollery Children’s Hospital, Children’s Hospital of Eastern Ontario, Health Sciences Centre Winnipeg, IWK Health Centre, London Health Sciences Centre Children's Hospital, CHU Sainte-Justine, Montreal Children’s Hospital, McMaster Children’s Hospital, Janeway Children’s Hospital and the Hospital for Sick Children.

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