P0371Appropriate Screening Strategy and Timely Referral in Suspected pIBD: Impact on Diagnostic Delay and Severity at Presentation

Abstract Background Pediatric-onset inflammatory bowel disease(pIBD) often presents with nonspecific symptoms, contributing to diagnostic delay(DD) and increased morbidity. Despite the importance of referral quality, few studies have systematically classified and analyzed diagnostic pathways in pIBD. The primary aim of this study was to assess the appropriateness of diagnostic pathways in pIBD, from first medical contact to endoscopy. Secondary aims included evaluating the impact of pathway adequacy on DD and early disease severity, and identifying factors associated with prolonged delay. Methods This retrospective, single-center observational study included 128 patients consecutively diagnosed with pIBD over a ten-year period, at a regional tertiary center in Italy. Pathways prior to referral to the pediatric gastroenterology service were classified as: appropriate when preceded by a general pediatrician(GP) evaluation, including fecal calprotectin(FC) and/or abdominal ultrasound(AUS); partially appropriate when referred by a GP or another specialist, without these investigations; inappropriate when the patient presented spontaneously to the emergency department (except in urgent cases) or was self-referred to an outpatient clinic. DD was defined as the time from symptom onset to endoscopy. Descriptive, univariate, and multivariate analyses were performed (significance p 0.05). Results Pathways were inappropriate in 60.9%, partially appropriate in 21.9%, and appropriate in 17.2%. The median DD was 3.9months(IQR:2.9–4.7), with no significant differences among groups. Clinical features influenced pathway adequacy (p 0.05): acute severe colitis(ASUC, OR = 32.2) and tenesmus(OR = 5.8) were associated with appropriate pathways, whereas fever and oral aphthosis with inappropriate ones. A shorter DD was independently associated (p 0.05) with: ASUC (B=–6.13months), hematochezia(B=–3.48months), fever(B=–4.25months), and weight loss(B=–3.42months). Regarding prereferral screening, 60.2% had FC measured and 42.2% underwent AUS; however, several patients with partial/completed screening were still inappropriately referred. Among those undergoing AUS, 51.9% showed bowel wall thickening ≥3 mm. AUS positivity rates differed by setting: 100% at our pediatric radiology service vs 33.3% for externally performed AUS (p 0.001). Conclusion Inappropriate pathways and lack of prereferral screening are highly prevalent although they do not consistently result in longer DD. Severe presentations may prompt earlier and more appropriate investigations. Systemic and extraintestinal manifestations are more likely to be associated with inappropriate pathways, suggesting limited early recognition. Standardized screening and referral protocols are essential to optimize pIBD management. References: 1. Ajbar A, Cross E, Matoi S, Hay CA, Baines LM, Saunders B, et al. Diagnostic delay in pediatric inflammatory bowel disease: a systematic review. Dig Dis Sci. 2022;67(12):5444-5454. 2. Martín-de-Carpi J, Jiménez Treviño S, Pujol Muncunill G, Martín-Masot R, Navas-López VM. Time to diagnosis in paediatric inflammatory bowel disease: key points for an early diagnosis. An Pediatr (Engl Ed). 2020;92(4):242.e1-242.e9. 3. Sulkanen E, Repo M, Huhtala H, Hiltunen P, Kurppa K. Impact of diagnostic delay on clinical presentation and associated factors in pediatric inflammatory bowel disease: a retrospective study. BMC Gastroenterol. 2021;21(1):364. 4. Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, et al. ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2014;58(6):795-806. Conflict of interest: Dr. Borgiani, Francesca: No conflict of interest Di Sario, Francesca: No conflict of interest Carciofi, Annalisa: No conflict of interest Gagliano, Chiara: No conflict of interest Brusco, Mario: No conflict of interest Franceschini, Elisa: No conflict of interest Lionetti, Maria Elena: No conflict of interest Gatti, Simona: No conflict of interest