DIAGNOSIS CHANGES IN PEDIATRIC IBD: DATA FROM THE IMPROVECARENOW REGISTRY. (21st January 2021)

• Record Type: Journal Article
• Authors: Sandberg, Kelly; Duarte, Harold; Stolfi, Adrienne; Saeed, Shehzad
• Is Part Of: Inflammatory bowel diseases. Volume 27(2021)Supplement 1
• Page Start: S42
• Page End: S43
• Publication Date: 2021-01-21
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izaa347.104
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Background: The change in subclassification of inflammatory bowel diseases (IBD) among patients with Crohn's (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-u) has previously been described in subpopulations of adult and pediatric patients. To date, no large, multinational registries have described characteristics of pediatric patients who change diagnosis. Methods: We used the largest (27, 628 individual patients for this study) prospective registry in the world for pediatric patients with IBD, ImproveCareNow R (ICN) to characterize those who change diagnosis. Diagnosis in the ICN registry is based on the Paris classification. Results: 7.52% of pediatric patients had any change in diagnosis; 5.19% of patients experienced a change in diagnosis after the initial 3 visits (Table 1). Those who start with a diagnosis of Crohn's are more likely to change, as compared with starting diagnoses of ulcerative colitis or IBD-u (p < 0.05). A majority of changes involve a diagnosis of IBD-u (75.8%, Figure 1). Among those who change diagnoses, those with initial diagnoses of Crohn's or IBD-u are more likely to have a BMI Z-score of less than -2, as compared to those with initial diagnosis of UC (p < 0.05). Patients with initial diagnosis of Crohn's who changed after 3 visits were less likely to have ileocolonic extent, penetrating or stricturing phenotype, or perianal disease documented (p < 0.05). Signs of initial miscoding occurred in less than 0.3% of patients. Discussion: This is the first reported use of a large prospective pediatric registry to investigate diagnosis changes within IBD. Registration diagnosis of Crohn's appears to have more clinically impactful findings than those with UC or IBD-u. A majority of all changes involved a diagnosis of IBD-unclassified. Further investigation of diagnosis changes across time and modeling will supplement our understanding of clinical factors predictive of change.