Diagnostic Delays in Inflammatory Bowel Disease
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.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 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 découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».