Jiménez Treviño Santiago, Pujol Muncunill Gemma, Martín-Masot Rafael, Rodríguez Martínez Alejandro, Segarra Cantón Oscar, Peña Quintana Luis, Armas Ramos Honorio, Eizaguirre Arocena Francisco Javier, Barrio Torres Josefa, García Burriel José Ignacio, Ortigosa Castillo Luis, Donat Aliaga Ester, Crujeiras Martínez Vanesa, Barros García Patricia, Botija Arcos Gonzalo, Bartolomé Porro Juan Manuel, Juste Ruiz Mercedes, Ochoa Sangrador Carlos, García Casales Zuriñe, Galicia Poblet Gonzalo, Oliver Goicolea Pablo, Lorenzo Garrido Helena, García Romero Ruth, La Orden Izquierdo Enrique, Pérez Solis David, Navas-López Víctor Manuel, Díaz Martin Juan José, Martín de Carpi Javier
Pediatrics Oviedo, Hospital Universitario Central de Asturias, Asturias, Spain.
Unit for the Comprehensive Care of Paediatric Inflammatory Bowel Disease, Hospital Sant Joan de Deu, Barcelona, Spain.
Front Pediatr. 2020 Oct 15;8:584278. doi: 10.3389/fped.2020.584278. eCollection 2020.
Diagnostic delay (DD) is especially relevant in children with inflammatory bowel disease, leading to potential complications. We examined the intervals and factors for DD in the pediatric population of Spain. We conducted a multicentric prospective study, including 149 pediatric inflammatory bowel disease patients, obtaining clinical, anthropometric, and biochemical data. Time to diagnosis (TD) was divided into several intervals to identify those where the DD was longer and find the variables that prolonged those intervals. Missed opportunities for diagnosis (MODs) were also identified. Overall TD was 4.4 months (interquartile range [IQR] 2.6-10.4), being significantly higher in Crohn's disease (CD) than in ulcerative colitis (UC) (6.3 [IQR 3.3-12.3] vs. 3 [IQR 1.6-5.6] months, p = 0.0001). Time from the visit to the first physician until referral to a pediatric gastroenterologist was the main contributor to TD (2.4 months [IQR 1.03-7.17] in CD vs. 0.83 months [IQR 0.30-2.50] in UC, p = 0.0001). One hundred and ten patients (78.3%) visited more than one physician (29.9% to 4 or more), and 16.3% visited the same physician more than six times before being assessed by the pediatric gastroenterologist. The number of MODs was significantly higher in CD than that in UC patients: 4 MODs (IQR 2-7) vs. 2 MODs ([IQR 1-5], p = 0.003). Referral by pediatricians from hospital care allowed earlier IBD diagnosis (odds ratio 3.2 [95% confidence interval 1.1-8.9], p = 0.025). TD and DD were significantly higher in CD than those in UC. IBD patients (especially those with CD) undergo a large number of medical visits until the final diagnosis.
诊断延迟（DD）在炎症性肠病患儿中尤为重要，可能导致潜在并发症。我们研究了西班牙儿科人群中诊断延迟的间隔时间和相关因素。我们开展了一项多中心前瞻性研究，纳入了149例儿科炎症性肠病患者，获取了临床、人体测量和生化数据。将诊断时间（TD）分为几个间隔时间段，以确定其中诊断延迟较长的时间段，并找出延长这些时间段的变量。还确定了诊断错失机会（MODs）。总体诊断时间为4.4个月（四分位间距[IQR] 2.6 - 10.4），克罗恩病（CD）的诊断时间显著高于溃疡性结肠炎（UC）（6.3 [IQR 3.3 - 12.3] 个月 vs. 3 [IQR 1.6 - 5.6] 个月，p = 0.0001）。从首次就诊到转诊至儿科胃肠病专家的时间是诊断时间的主要构成部分（CD为2.4个月 [IQR 1.03 - 7.17]，UC为0.83个月 [IQR 0.30 - 2.50]，p = 0.0001）。110例患者（78.3%）就诊过不止一位医生（29.9%就诊过4位或更多医生），16.3%在接受儿科胃肠病专家评估前多次（超过6次）就诊于同一位医生。CD患者的诊断错失机会数量显著高于UC患者：4次错失机会（IQR 2 - 7） vs. 2次错失机会（IQR 1 - 5），p = 0.003）。医院护理的儿科医生转诊可使炎症性肠病更早诊断（优势比3.2 [95%置信区间1.1 - 8.9]，p = 0.025）。CD的诊断时间和诊断延迟显著高于UC。炎症性肠病患者（尤其是CD患者）在最终确诊前要经历大量的就医过程。
