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P239. Diagnostic delay in pediatric Crohn's disease patients is longer than in pediatric ulcerative colitis patients

A. Schoepfer1, E. Safroneeva2, N. Fournier3,4, G. Rogler5, A. Nydegger6, S. Vavricka5, C. Braegger7, 1Centre Hospitalier Universitaire Vaudois, Gastroenterology, Lausanne, Switzerland, 2University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, 3Institute of Social and Preventive Medicine, Healthcare Evaluation Unit, Lausanne, Switzerland, 4University of Lausanne, IUMSP, Lausanne, Switzerland, 5University of Zurich, Gastroenterology and Hepatology, Zurich, Switzerland, 6University of Lausanne, Pediatric Gastroenterology, Lausanne, Switzerland, 7University of Zurich, Pediatric Gastroenterology, Zurich, Switzerland

Background

We have recently shown that the median diagnostic delay (time from first IBD symptoms until IBD diagnosis is established) was 9 months in adult Crohn's disease patients and 4 months in adult ulcerative colitis (UC) patients in Switzerland. Of note, 25% of CD patients had a diagnostic delay >24 months. We also showed that the length of diagnostic delay in CD patients represents a risk factor for complicated disease course and intestinal surgery. There is a lack of data regarding diagnostic delay in pediatric IBD patients. We aimed to assess the diagnostic delay in pediatric CD and UC patients and to identifiy risk factors for long diagnostic delay.

Methods

Data from the Swiss IBD cohort study were analyzed. Patients were recruited from university centers (68%), regional hospitals (14%), and private practices (18%). Data on diagnostic delay was provided by parents and physician questionnaires. Diagnostic delay was further divided into the time interval from first symptoms to the first consultation with the physician (patient-related interval) and the interval from first physician consultation until IBD diagnosis was established (physician related interval). Long diagnostic delay was defined as delay lying above the 75th percentile. Non-normal data are presented as median, interquartile range [IQR] and range.

Results

A total of 100 pediatric CD (37% females) patients and 75 pediatric UC patients (56% females) were included. Age at disease onset was 12 [10–14] years in CD and 11 [7–13] years in UC patients. Diagnostic delay in CD was 4 [2–8] (range 0–82) months with the interval from first symptoms to physician visit of 1 [0–3] (range 0–24) months and from physician visit to diagnosis of 3 [1–9] (range 0–82) months. In UC patients the median diagnostic delay was 2 [1–7] (range 0–52) months with an interval from first symptom onset to physician visit of 0 [0–3] (range 0–36) months and from physician visit to diagnosis of 2 [1–4] (range 0–20) months. Diagnostic delay in CD patients was significantly longer than in UC patients (median 4 vs. 2 months, p = 0.011). Long diagnostic delay was defined as period >8 months in CD and >7 months in UC patients. Neither gender, age at diagnosis, disease location, positive IBD family history, nor provenience (rural vs. non-rural) were associated with long diagnostic delay.

Conclusion

The median diagnostic delay in pediatric CD and UC patients in Switzerland is 4 and 2 months, respectively. However, one fourth of pediatric CD patients needs >8 months and one fourth of pediatric UC patients needs >7 months from first symptom onset to IBD diagnosis.