Quality improvement project identifies factors associated with delay in IBD diagnosis
Author
Walker, Gareth
Lin, Simeng
Chanchlani, Neil
Thomas, Amanda
Hendy, Peter
Heerasing, Neel
Moore, Lucy
Chee, Desmond
Bewshea, Claire
Mays, Joseph
Kennedy, Nicholas A.
Ahmad, Tariq
Goodhand, James R.
Date
2020-08Journal
Alimentary Pharmacology and TherapeuticsType
Journal ArticlePublisher
WileyDOI
10.1111/apt.15885Rights
© 2020 John Wiley & Sons LtdMetadata
Show full item recordAbstract
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.