Quality improvement project identifies factors associated with delay in IBD diagnosis
Quality improvement project identifies factors associated with delay in IBD diagnosis
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DOI：
10.1111/apt.15885
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发表时间：
2020-06-23
影响因子：
7.6
通讯作者：
Goodhand, James R.
中科院分区：
文献类型：
--
作者：
Walker, Gareth J.;Lin, Simeng;Goodhand, James R.
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. Emergent presentation is common and, unlike a delayed time to diagnosis, is associated with a complicated disease course.
