Quality improvement project identifies factors associated with delay in IBD diagnosis

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.

Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User’s Guide for Adult and Pediatric Gastroenterologists

“…Delay in diagnosis is more common in CD than UC (median delay, 7.6 months; interquartile range [IQR], 3.1-15.0 months and 3.3 months; IQR, 1.9-7.3 months, respectively; P < .001). 24 Data from the Swiss IBD cohort demonstrate that CD diagnosis can be delayed in pediatric and adult patients by 3 months (IQR, 1-9 months) and 6 months (IQR, 1-24 months), respectively. Adults were more likely to present with strictures (P < .001) and require bowel surgery (P < .001).…”

Analysis of Medical Seeking Behavior and Influencing Factors in Patients With Chronic Obstructive Pulmonary Disease

“…92% of patients were diagnosed within 2 years of symptoms and 50% were diagnosed within 4 months. 20 Compared with other studies, the diagnosis delay in COPD patients was longer; it may result from that COPD was a chronic disease with a longer disease process and gradual aggravation of symptoms, while patients with other digestive diseases such as IBD often had diarrhea and blood in the stool as the rst symptoms, so they were more likely to catch symptoms early, and these symptoms were more di cult to tolerate.…”

Analysis of diagnostic delay and its influencing factors in patients with chronic obstructive pulmonary disease: a cross-sectional study

“…In a recent retrospective study, it was found that nearly half of the liver www.nature.com/scientificreports/ cirrhosis patients delayed the diagnosis of hepatocellular carcinoma (HCC) in 60 days or more after danger signs 17 . A new study from the United Kingdom has shown that diagnostic delay may exist in patients with inflammatory bowel disease (IBD); precisely, 92% of the patients were diagnosed within 2 years of the development of the symptoms and 50% were diagnosed within 4 months 18 . The diagnostic delay in COPD patients was relatively long, which might result from COPD being a chronic disease with a longer disease process and gradual aggravation of symptoms.…”