Diagnostic delay in Canadian children with inflammatory bowel disease is more common in Crohn's disease and associated with decreased height

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.

Keywords: gastroenterology; general paediatrics; growth.