Diagnostic Delays in Inflammatory Bowel Disease
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Notice bibliographique
Résumé
Introduction: Canada has the highest reported incidence and prevalence of inflammatory bowel disease (IBD) in the world. IBD has significant impact on quality of life and also a substantial economic burden on health care system, amounting to $12,000 annually per patient with IBD. Earlier diagnoses of IBD and earlier therapeutic interventions have been associated with reduction in surgical and hospitalization rates in patients with IBD. A significant challenge in the diagnosis of IBD is its similarities with Irritable bowel syndrome (IBS), as patients present with similar symptoms including diarrhea and abdominal pain. The gold standard for distinguishing the two is a colonoscopy, which remains a scarce resource. Our objective is to determine the time to diagnosis of newly referred patients with suspected IBD. We evaluate new referrals with suspected IBD and determine the wait times both to be seen in the clinic and to undergo an endoscopic evaluation. Methods: We performed a retrospective chart review looking at new referrals to IBD clinic from January 2013 to December 2013. All new consultations were reviewed and data pertaining to patient demographic, disease onset, disease severity, referral, and triage process were recorded. Patients who have been seen previously in the IBD clinic and patients who failed to attend their appointment were excluded. Clinic wait time, time to endoscopy, diagnostic delay was determined. Results: In total 145 charts were reviewed. Out of these 62 patients had a previous diagnosis of IBD and 69 patients were undifferentiated. Looking at the latter group, 23 patients were diagnosed with IBS, 7 with Crohn’s disease, and 6 with ulcerative colitis. There were no significant differences in clinic wait times and endoscopy times for patients diagnosed with IBD vs. IBS (p=0.78, p=0.67 respectively). Diagnostic delays were significantly different for patients with IBD vs. IBS at 17 months and 60 months respectively (p=0.003). Conclusion: Comparable wait times and endoscopy times for patients with IBD and IBS are consistent with their clinical similarities. However, they also suggest the need for better triaging process and noninvasive diagnostic studies to risk stratify patients. We plan to study this further by closely looking at referrals, formulating a standardized referral form. In addition to this, we plan to study whether triage on basis of fecal calprotectin will have an effect on wait times and diagnostic delays.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle