Childhood onset inflammatory bowel disease: predictors of delayed diagnosis from the CEDATA German-language pediatric inflammatory bowel disease registry.
OBJECTIVE
To examine predictors of delayed diagnosis of inflammatory bowel disease in children and adolescents.


METHODS
A total of 2,436 patients (age 0-18 years) with Crohn's disease, ulcerative colitis, or unclassified colitis were included from 53 pediatric gastroenterologists. Predictors were examined with the proportional hazards model, presented as hazard ratios (HR) with 95% confidence intervals. HR < 1.0 represent factors associated with late diagnosis.


RESULTS
Median time to diagnosis was 4 (2-8) months. Crohn's disease (HR 0.62; 0.56-0.68), and within Crohn's disease, ileal disease (HR 0.77, 95% confidence interval 0.67 to 0.89) were associated with delayed diagnosis. Chances for early diagnosis increased with increasing age (HR 1.07 per year of age; 1.06 to 1.08). There was also an effect by center (HR 0.63, 0.52 to 0.67), but not by sex or country (Austria vs Germany). Growth failure was more common in those cases with delayed diagnosis.


CONCLUSIONS
There is still concern about delays in the diagnosis of inflammatory bowel disease in the very young and in children with small bowel disease. Inequalities of care by region require further investigation.
HelmholtzZentrum München, German Research Centre for Health and Environment, Department of Epidemiology, Neuherberg, Germany.
Antje
A
Timmer
Rolf
R
Behrens
Stephan
S
Buderus
Annette
A
Findeisen
Almuthe
A
Hauer
Klaus-Michael
KM
Keller
Guido
G
Kliemann
Thomas
T
Lang
Wolfgang
W
Lohr
Peter
P
Rzehak
Sibylle
S
Koletzko
D000293:Adolescent; D001317:Austria / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000175:diagnosis / Q000453:epidemiology; D057210:Delayed Diagnosis / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006130:Growth Disorders / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors