Diagnostic Delay Is Associated with Complicated Disease and Growth Impairment in Pediatric Crohn’s Disease

Diagnostic Delay Is Associated with Complicated Disease and Growth Impairment in Pediatric Crohn’s Disease

Methods: We conducted a national, prospective multi-centre IBD inception cohort study, including 1399 children. Diagnostic delay was defined as time from symptom onset to diagnosis >75 th 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% CD, 36% UC/IBD-U; 57% male), median time to diagnosis was 4.2 (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-times higher rate of strictures/internal fistulae (HR 2.53, 95% CI 1.41-4.56). Every additional month of diagnostic delay was associated with a decrease in height-for-age z-score of 0.13 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.