Background: Delays in diagnosis are unfortunately quite common in most health systems. It is apparent that timely diagnosis is more likely to have a favourable outcome. However, there may be many reasons why timely diagnosis is not always achieved. The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs). Methods: New patients referred for suspected IBD to a single tertiary care centre between January 2013 to December 2017 were identified using EMR. For purposes of the study, a cut-off time was set by investigators for each delay-type based on best average hospital waiting times. The reasons for delays in patient journey until start of treatment and data on pre-defined AOs (steroid median age = 32 y) with a long median follow-up of 55 months. 65, 27 and 13 patients had final diagnosis of Ulcerative colitis, Crohn’s disease and Unclassified colitis respectively, and analysed collectively. In our cohort, the longest delay-types noted were—patients seeking medical attention (median = 4 months; range 1 to 84 months), arranging gastroenterology clinic review after referral from primary care (median = 5 weeks; range 1 to 30 weeks), and waiting for index endoscopy (median = 3 weeks; 1 to 36 weeks). Patient stratification based on delay-type using specific cut-off times for each showed a statistically significant difference in survival without AOs for all (when comparing delay v/s no delay). Conclusions: In our cohort we report that delays, and subsequent untreated chronic inflammation, leads to poor outcomes in patients with newly diagnosed IBD regardless of whether delays are patient-related or health-system-related. Also, cumulative delays in the hospital appear to increase the use of biologics in consecutive years. Understanding these factors help rectify and offer long-term solutions.
Shivaji et al. (Mon,) studied this question.