Arcos-Machancoses J V, Donat-Aliaga E, Polo-Miquel B, Masip-Simó E, Ribes-Koninckx C, Pereda-Pérez A
Unidad de Gastroenterología y Hepatología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España.
Unidad de Gastroenterología y Hepatología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España.
An Pediatr (Barc). 2015 Apr;82(4):247-54. doi: 10.1016/j.anpedi.2014.05.024. Epub 2014 Sep 23.
Diagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment. The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease.
A retrospective study of the information collected from primary care medical records and that from the pediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out on 53 patients: 31 with Crohn's disease, 19 with ulcerative colitis, and 3 with unclassified pediatric inflammatory bowel disease. The main response variable was the interval from the first physician-patient contact to diagnosis.
The median time to diagnosis was 12 weeks (interquartile range 5-24). However for 26.3% of the ulcerative colitis cases and 25.8% of the Crohn's disease cases, the interval was longer than 1 year. There was a more marked delay trend in Crohn's disease cases, but it was not statistically significant. None of the evaluated risk factors was associated with a relevant diagnostic delay, although it tended to be longer in younger children.
Whereas the median delay for pediatric inflammatory bowel disease seems to be acceptable, the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics. Further research into lost diagnostic opportunities needs to be carried out.
儿童炎症性肠病的诊断延迟可能导致并发症及治疗反应不佳。对诊断延迟及其决定因素进行研究，可能有助于采取纠正措施并改善疾病预后。
对2000年至2012年间从基层医疗记录以及一家三级医院儿科胃肠病科收集的信息进行回顾性研究，共纳入53例患者：31例克罗恩病患者、19例溃疡性结肠炎患者以及3例未分类的儿童炎症性肠病患者。主要反应变量为从首次医患接触到确诊的时间间隔。
确诊的中位时间为12周（四分位间距5 - 24周）。然而，26.3%的溃疡性结肠炎病例和25.8%的克罗恩病病例的时间间隔超过1年。克罗恩病病例的延迟趋势更为明显，但无统计学意义。尽管年幼儿童的诊断延迟往往更长，但所评估的风险因素均与显著的诊断延迟无关。
虽然儿童炎症性肠病的中位延迟似乎可以接受，但对于很大一部分具有不同临床特征的儿童来说，诊断时间跨度相当长。需要对错失的诊断机会进行进一步研究。
