Diagnostic Delay Is Associated with Complicated Disease and Growth Impairment in Paediatric Crohn's Disease

Authors

Amanda Ricciuto, Hospital for Sick Children University of Toronto
David R. Mack, Children's Hospital of Eastern Ontario, Ottawa
Hien Q. Huynh, University of Alberta
Kevan Jacobson, BC​ Children​'​​s Hospital
Anthony R. Otley, IWK Health Centre
Jennifer Debruyn, University of Calgary
Wael El-Matary, Max Rady College of Medicine, University of Manitoba
Colette Deslandres, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant
Mary E. Sherlock, McMaster Children's Hospital
Jeffrey N. Critch, New Janeway Children’s Health and Rehabilitation Centre
Kevin Bax, Children's Hospital of Western OntarioFollow
Prevost Jantchou, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant
Ernest G. Seidman, Centre Universitaire de Santé McGill, Hôpital de Montreal Pour Enfants
Nicholas Carman, Children's Hospital of Eastern Ontario, Ottawa
Mohsin Rashid, IWK Health Centre
Aleixo Muise, Hospital for Sick Children University of Toronto
Eytan Wine, University of Alberta
Matthew W. Carroll, University of Alberta
Sally Lawrence, BC​ Children​'​​s Hospital
Johan Van Limbergen, IWK Health Centre
Eric I. Benchimol, Children's Hospital of Eastern Ontario, Ottawa
Thomas D. Walters, Hospital for Sick Children University of Toronto
Anne M. Griffiths, Hospital for Sick Children University of Toronto
Peter C. Church, Hospital for Sick Children University of Toronto

Document Type

Article

Publication Date

3-1-2021

Journal

Journal of Crohn's and Colitis

Volume

15

Issue

3

First Page

419

Last Page

431

URL with Digital Object Identifier

10.1093/ecco-jcc/jjaa197

Abstract

Background: Paediatric data on the association between diagnostic delay and inflammatory bowel disease [IBD] complications are lacking. We aimed to determine the effect of diagnostic delay on stricturing/fistulising complications, surgery, and growth impairment in a large paediatric cohort, and to identify predictors of diagnostic delay. Methods: We conducted a national, prospective, multicentre IBD inception cohort study including 1399 children. Diagnostic delay was defined as time from symptom onset to diagnosis >75th percentile. Multivariable proportional hazards [PH] regression was used to examine the association between diagnostic delay and stricturing/fistulising complications and surgery, and multivariable linear regression to examine the association between diagnostic delay and growth. Predictors of diagnostic delay were identified using Cox PH regression. Results: Overall (64% Crohn's disease [CD]; 36% ulcerative colitis/IBD unclassified [UC/IBD-U]; 57% male]), median time to diagnosis was 4.2 (interquartile range [IQR] 2.0-9.2) months. For the overall cohort, diagnostic delay was >9.2 months; in CD, >10.8 months and in UC/IBD-U, >6.6 months. In CD, diagnostic delay was associated with a 2.5-fold higher rate of strictures/internal fistulae (hazard ratio [HR] 2.53, 95% confidence interval [CI] 1.41-4.56). Every additional month of diagnostic delay was associated with a decrease in height-for-age z-score of 0.013 standard deviations [95% CI 0.005-0.021]. Associations persisted after adjusting for disease location and therapy. No independent association was observed between diagnostic delay and surgery in CD or UC/IBD-U. Diagnostic delay was more common in CD, particularly small bowel CD. Abdominal pain, including isolated abdominal pain in CD, was associated with diagnostic delay. Conclusions: Diagnostic delay represents a risk factor for stricturing/internal fistulising complications and growth impairment in paediatric CD.