P617. Impact of diagnostic delay on clinical outcome of Crohn's disease (CD)
The diagnosis of Crohn's Disease (CD) can be difficult and it is frequently associated with diagnostic delay. The aim of this study was to evaluate whether the diagnostic delay is correlated with more severe outcome of CD.
The study recruited a consecutive series of CD patients, regularly followed in a tertiary centre for IBD care, over a 12-month period (September 2012-September 2013). The following data were obtained: sex, age, date of onset of symptoms and date of definite diagnosis of CD, location of disease at diagnosis, smoking habit, appendectomy prior diagnosis, date and kind of therapy, current and past medical treatments for CD, history of perianal disease and history of surgery that included date, number, kind (resective or conservative) and indications (refractoriness, stenosis, fistulae or abscesses).
The following variables were considered of poor outcome of CD: intestinal surgery after diagnosis, time from CD diagnosis to intestinal surgery, number of intestinal surgeries for CD complications during the follow up, use of immunosuppressant or biologics for steroid refractory CD, time from CD diagnosis to the first use of immunosuppressant or biologics.
The diagnostic delay was defined as the time period (in months) from first symptoms to CD diagnosis and was stratified in four groups according to the quartiles. Differences between groups were assessed using analysis of variance, Kruskal–Wallis and χ2 tests where appropriate.
A total of 351 patients were enrolled and stratified in the following quartiles of diagnostic delay: ≤1.03, 1.03–7.10, 7.1–26.4 and >26.4 months. The median diagnostic delay was 7.1 (range 0–324 months). The diagnostic delay was greater in patients with advanced age at diagnosis (p < 0.001) and in patients with previous appendectomy (p: 0.013).
Diagnostic delay was significantly associated with surgery for CD, with the number of operations and with increased rate of intraoperative diagnosis of CD. The time interval between diagnosis and first surgery was also shorter, although not significantly, in patients with greater diagnostic delay (Table).
|Diagnostic delay||1st quartile||2nd quartile||3rd quartile||4th quartile||P|
|Yes||57 (57%)||31 (40.3%)||42 (48.3%)||59 (67.8%)|
|No||43 (43%)||46 (59.7%)||45 (51.7%)||28 (32.2%)|
|Number of operations||0.028|
|1||39 (66.1%)||20 (64.5%)||26 (61.8%)||28 (47.5%)|
|2||17 (28.8%)||2 (6.5%)||12 (28.6%)||19 (32.2%)|
|≥3||3 (5.1%)||9 (29.0%)||4 (9.6%)||12 (20.3%)|
|Intraoperative diagnosis||21 (21%)||10 (13%)||9 (10.3%)||21 (24.1%)||0.052|
|Time between diagnosis and first surgery (mo)||77.3±87.0||88.5±97.4||90.8±95.9||69.1±101.1||0.079|
The length of diagnostic delay may be a risk for surgery and number of operations, but it does not seem to be associated with an increased use of immunosuppressive and or biologic therapy in the disease course.