6028 Quality improvement audit on management of crohn’s disease in pediatric patients: a retrospective analysis of 2022 data

Objectives The primary objective of this audit was to advocate for adherence to ESPGHAN guidelines among clinicians, with a specific focus on avoiding the unnecessary use of potent medications in the care of pediatric patients with Crohn's disease. Conducted at the Irish Paediatric Gastroenterology Center within CHI Crumlin, this audit aimed to comprehensively assess the management practices applied to the 71 pediatric patients diagnosed with Crohn's disease in 2022. By reviewing the care and treatment received by these young patients, our goal was to promote standardized, evidence-based practices that prioritize their well-being while minimizing the use of intensive medications when alternative approaches may suffice. This endeavor underscores our unwavering commitment to delivering the highest quality of care to our pediatric population and enhancing their overall health outcomes. Methods For this quality improvement audit, we conducted retrospective data collection on all patients diagnosed with Crohn's disease in 2022, subsequently comparing the gathered data with ESPGHAN guidelines. The inclusion criteria encompassed all patients diagnosed with Crohn's disease at Crumlin Children's Hospital during 2022. Exclusion criteria applied to 19 out of the 71 patients due to data unavailability within our systems and challenges encountered in obtaining the necessary information. Data was meticulously extracted from medical records and systematically organized in an Excel spreadsheet, facilitating efficient management and analysis. Results Among the 71 patients diagnosed with Crohn's disease, 52 were included in the audit. EEN therapy was administered to 38 (73.1%) patients for disease initiation (graph 2). Out of these, 5 (9.6%) continued a regular diet, 3 (5.8%) followed a disease-specific diet, and one followed a partial diet (1.9%). Diet details were missing for 5 patients. The remaining 5 patients were placed on corticosteroids for induction therapy. Various forms of perianal involvement were observed (graph 4), with 13.5% having large skin tags, 9.6% small skin tags, 7.7% fistulas, 1.9% abscess, and 1.9% both abscess and fistula. A total of 31 (59.6%) patients had no recorded perianal disease, while information was unspecified for 3 (5.8%) patients. For disease maintenance, 44 (84.6%) received Anti-TNF medications, 2 (3.8%) took methotrexate, and 6 (11.5%) utilized mesalazine. Among those on Anti-TNF medication, 34 (81.8%) followed ESPGHAN guidelines, while 10 (18.2%) did not. The Paediatric Crohn's Disease Activity Index (PCDAI) scores were assessed for 52 patients: 2 (3.8%) had scores below 10, 19 (36.5%) scored between 10–29, and 27 (51.9%) scored between 30–59. Insufficient data prevented the calculation of PCDAI scores of 4 patients. Conclusion In conclusion, a comprehensive analysis of the audit data indicates that a significant majority of patients (34/44) were managed in accordance to ESPGHAN guidelines. However, 10 patients were not managed as prescribed, and further evaluation suggested that their clinical profile and overall risk for poor outcomes were acessed to be low. Therefore, Methotrezate, thiopurine or maintenance enteral nutrition should have been considered aligning with ESPGHAN guidelines. Reference The Medical Management of Paediatric Crohn's Disease: an ECCO-ESPGHAN Guideline Update (2020, October 7), Journal of Crohn's and Colitis Volume 15 Issue 2. https://academic.oup.com/ecco-jcc/article/15/2/171/5918800