Quality improvement project identifies factors associated with delay in IBD diagnosis
Open Access
- 23 June 2020
- journal article
- research article
- Published by Wiley in Alimentary Pharmacology & Therapeutics
- Vol. 52 (3), 471-480
- https://doi.org/10.1111/apt.15885
Abstract
Background Delay in the diagnosis of inflammatory bowel disease (IBD) is common and contemporary UK studies are lacking. Aim To determine factors associated with, and the consequences of, a prolonged time to diagnosis in IBD. Methods This quality improvement study included 304 adults with a new IBD diagnosis made between January 2014 and December 2017 across 49 general practices (GP) and gastroenterology secondary care services. Outcome measures were demographic, clinical and laboratory factors associated with a delayed time, defined as greater than upper quartile, to: (a) patient presentation (b) GP referral (c) secondary care diagnosis, and factors associated with a complicated disease course (hospitalisation and/or surgery and/or biologic treatment) in the year after diagnosis. Results The median [IQR] diagnosis sub‐intervals were: (a) patient = 2.1 months [0.9‐5.1]; (b) GP = 0.3 months [0.0‐0.9]; (c) secondary care = 1.1 months [0.5‐2.1]. 50% of patients were diagnosed within 4 months and 92% were diagnosed within 2 years of symptom onset. Diagnostic delay was more common in Crohn's disease (7.6 months [3.1‐15.0]) than ulcerative colitis (3.3 months [1.9‐7.3]) (P < 0.001). Patients who presented as an emergency (P < 0.001) but not those with a delayed overall time to diagnosis (P = 0.35) were more likely to have a complicated disease course. Conclusion Time to patient presentation is the largest component of time to IBD diagnosis. Emergency presentation is common and, unlike a delayed time to diagnosis, is associated with a complicated disease course.Keywords
This publication has 26 references indexed in Scilit:
- Natural Disease Course of Ulcerative Colitis During the First Five Years of Follow-up in a European Population-based Inception Cohort—An Epi-IBD StudyJournal of Crohn's and Colitis, 2018
- Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgeryWorld Journal of Gastroenterology, 2017
- Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's diseaseAlimentary Pharmacology & Therapeutics, 2015
- Randomised clinical trial: deep remission in biologic and immunomodulator naïve patients with Crohn's disease – a SONIC post hoc analysisAlimentary Pharmacology & Therapeutics, 2015
- Diagnostic delay in a French cohort of Crohn's disease patientsJournal of Crohn's and Colitis, 2014
- East–West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohortGut, 2013
- Subgroup analysis of the placebo-controlled CHARM trial: Increased remission rates through 3years for adalimumab-treated patients with early Crohn's diseaseJournal of Crohn's and Colitis, 2013
- Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel diseaseInflammatory Bowel Diseases, 2012
- Increased Response and Remission Rates in Short-Duration Crohn's Disease With Subcutaneous Certolizumab Pegol: An Analysis of PRECiSE 2 Randomized Maintenance Trial DataThe American Journal of Gastroenterology, 2010
- Impact of inflammatory bowel disease on quality of life: Results of the European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA) patient surveyJournal of Crohn's and Colitis, 2007