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Sa1997 Identifying Fistulizing Crohn's Disease in a National Pediatric Inflammatory Bowel Disease Quality Improvement Collaborative Registry
Table 1. Period Prevalence of Perianal Fistulizing Phenotype within the first 1-Year and 5-Years After Diagnosis
Table 2. Perianal Fistulizing Disease in Early Onset IBD Diagnosed Before 10 Years of Age Sa1998 "But I'm Feeling Fine!" A Comparison of Parent and Child Symptom-Report Among Pediatric Patients With Inflammatory Bowel Disease Rachel C. Lawton, Ruben J. Colman, Robert Rothbaum, Michelle LaRose-Wicks, Jason Washburn Background: Research that assesses parent-child agreement in symptom-reporting among pediatric patients with Inflammatory Bowel Disease (IBD) is scarce. While limited research has explored dyadic agreement for IBD activity scores between patients and their physicians, little work has investigated this agreement between pediatric patients and their parents. This study aimed to compare and contrast parent and child symptom assessment among pediatric IBD patients. Methods: A prospective cohort of pediatric IBD patients and parent dyads independently completed a questionnaire about IBD-related symptoms. Questions were administered via a Likert-scale and assessed for disease activity and alarm symptoms. This specific assessment tool included 7 questions about current general wellbeing, abdominal pain, blood in stool, joint pain, appetite, and weight loss. In addition, disease- and patient demographics were also collected. Modified Bland-Altman plots were constructed to assess agreement between dyads. Linear regression was used to assess for proportional bias between mean total health scores per dyad. Results: 36 dyads (patients and parents) completed questionnaires. Parent report was comprised of 34 mothers and 2 fathers. Mean age of the youth participating was 13.6 years, with a SD of 1.9 years (R=10-18). Seventy-five percent of patients were diagnosed more than 1 year prior to this assessment, 39% (14/36) were on anti-TNF therapy, 14% (5/36) had a history of PICC line placement, and 28% (10/36) reported a history of IBD-related surgery. Parent-child IBD-symptom agreement was perfect in 22% (n=8) of dyads. Twenty-five percent (n=9) of patients reported greater symptomology than parents. In contrast, parents reported greater symptom severity in the majority (53%, n=19) of parent-patient dyads. Linear regression analyses suggest that the magnitude of the total health score itself did not predict the presence and magnitude of parent-child dyadic agreement (t=-0.20, P=0.84). Bland-Altman plots (Figure 1) illustrate that patients and parents agreed most on presence of blood in stool and agreed least on the presence or absence of weight loss. Conclusion: While a percentage of parents and pediatric patients conceptualize their current IBD symptoms in a similar fashion, parent report often describes a symptomatic presentation that is more severe than the child's report herself. This finding is consistent with other research that suggests that parent report tends to portray symptoms that are more severe, either by frequency or subsequent impairment. Clinicians should be mindful of the manner by which choice of reporter may influence both the presentation and assessment of their pediatric patient. Future research should attempt to more clearly understand the etiology of this discordance and the possible implications and clinical consequences of its presence.
Sa1997 Identifying Fistulizing Crohn's Disease in a National Pediatric Inflammatory Bowel Disease Quality Improvement Collaborative Registry Jeremy Adler, Shiming Dong, Kevin Dombkowski Background: Perianal fistulas are a common complication of Crohn's disease (CD). Little population-based data are available to describe the epidemiology of fistulizing disease in pediatric CD. We sought to characterize the prevalence of fistulizing CD using in a large population of pediatric CD patients. Methods: We used the ImproveCareNow (ICN) Network registry of prospectively collected visit-level data to identify CD patients (May 2006-October 2014). ICN is a multicenter pediatric inflammatory bowel disease (IBD) quality improvement collaborative (65 sites contributed data). Clinicians document physical examination and Paris phenotype classification at each outpatient IBD visit. Fistula noted on exam and concomitant change in phenotype were used to corroborate time of new-onset perianal fistulas. Period prevalence of perianal fistulizing phenotype was determined by first occurrence of perianal fistula within the first 1- and 5-years after IBD diagnosis and was stratified by age, gender, race and geographic region. The prevalence was compared across groups (chi square). Results: The ICN registry included 10,969 patients (44% female); 7,076 (65%) were classified as having CD and 397 (5.6%) were excluded for missing/conflicting entries. Complete data were available for calculating period prevalence of perianal fistulizing phenotype within the first 1-year in 5,562 (83%) and 5-year in 2,170 (35%) patients (Table 1). Overall, 21% developed perianal fistula within 1-year and was identical among the 5-year prevalence group (21%). Males were more likely to develop a perianal fistula by 1-year (22% vs. 19%; p=0.02) and similarly by 5-years (p=0.07). There was no difference by age at time of IBD diagnosis for fistula development by 1-year (p=0.3), although by 5-years fistulas were more prevalent among those diagnosed between 6-10 years of age (p=0.04). Perianal fistula was most common among Blacks and least among Whites at 1-year (25% vs. 20%; p=0.08) and at 5-years (30% vs. 20%; p=0.02). Early onset CD (before age 10 years; Table 2) was most common in Asians (40%; p<0.001). Among early onset CD, the greatest prevalence of fistulas within the first year was seen in Blacks (32%; p=0.004). Regionally, the greatest prevalence of fistulas was found in the Northeast and least in the Midwest by 1-year (26% vs. 16%; p<0.001) and by 5-years (27% vs. 15%; p<0.001). Conclusions: In this large multicenter study of pediatric IBD, regional and racial differences in the development of perianal fistulas were found. Our findings indicate that perianal fistulas are common and occur early in pediatric CD. Consequently early therapy should be aimed at fistula prevention. These findings support the use of the ICN registry for conducting population-based studies and suggest that additional studies to evaluate comparative effectiveness of preventive therapies are warranted.
S-379
AGA Abstracts
AGA Abstracts
serious infections, including varicella and zoster. Additionally, this population remains underimmunized against varicella, and concerns exist regarding the safety and efficacy of this immunization in immunosuppressed patients. We aimed to evaluate the risk of varicellaand zoster-related hospitalization among children with IBD. Methods: A retrospective cohort study was performed utilizing data on varicella- and zoster-related hospitalizations from the 1997, 2000, 2003, 2006, 2009, and 2012 triennial Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID). Hospitalizations with a primary diagnosis of varicella or herpes zoster were compared between children (ages 5 to 21) with and without IBD using logistic regression. Results: There were 12,219,138 admissions in the HCUP-KID database from 1997-2012, including 4,434 with varicella and 4,488 with zoster listed as the primary diagnosis. Children with IBD accounted for 57 (1.29%) and 74 (1.64%) of the varicella- and zoster-related hospitalizations, respectively. Primary admissions for varicella or zoster accounted for 0.4% of all hospitalizations of children carrying a diagnosis of IBD. Compared to children without IBD, those with IBD were at significantly higher risk for varicella-related hospitalization (OR 4.98, 95% CI 3.84-6.47) and zoster-related hospitalization (OR 6.35, 95% CI 5.04-7.99). This risk was higher among children with Crohn's disease (varicella OR 6.22, 95% CI 4.65-8.32, zoster OR 7.39, 95% CI 5.67-9.65) compared to children with ulcerative colitis (varicella OR 2.69, 95% CI 1.50-4.81, zoster OR 4.34, 95% CI 2.75-6.85). Conclusion: Children with IBD are at increased risk for varicella- and zosterrelated hospitalization. These results highlight the importance of efforts to immunize IBD patients without a history of varicella disease or varicella immunization, ideally before the initiation of immunosuppressive therapy. Furthermore, research is needed on the safety and efficacy of varicella vaccine in children with IBD on immunomodulators including antitumor necrosis factor-alpha agents.
Table 2. Perianal Fistulizing Disease in Early Onset IBD Diagnosed Before 10 Years of Age Sa1998 "But I'm Feeling Fine!" A Comparison of Parent and Child Symptom-Report Among Pediatric Patients With Inflammatory Bowel Disease Rachel C. Lawton, Ruben J. Colman, Robert Rothbaum, Michelle LaRose-Wicks, Jason Washburn Background: Research that assesses parent-child agreement in symptom-reporting among pediatric patients with Inflammatory Bowel Disease (IBD) is scarce. While limited research has explored dyadic agreement for IBD activity scores between patients and their physicians, little work has investigated this agreement between pediatric patients and their parents. This study aimed to compare and contrast parent and child symptom assessment among pediatric IBD patients. Methods: A prospective cohort of pediatric IBD patients and parent dyads independently completed a questionnaire about IBD-related symptoms. Questions were administered via a Likert-scale and assessed for disease activity and alarm symptoms. This specific assessment tool included 7 questions about current general wellbeing, abdominal pain, blood in stool, joint pain, appetite, and weight loss. In addition, disease- and patient demographics were also collected. Modified Bland-Altman plots were constructed to assess agreement between dyads. Linear regression was used to assess for proportional bias between mean total health scores per dyad. Results: 36 dyads (patients and parents) completed questionnaires. Parent report was comprised of 34 mothers and 2 fathers. Mean age of the youth participating was 13.6 years, with a SD of 1.9 years (R=10-18). Seventy-five percent of patients were diagnosed more than 1 year prior to this assessment, 39% (14/36) were on anti-TNF therapy, 14% (5/36) had a history of PICC line placement, and 28% (10/36) reported a history of IBD-related surgery. Parent-child IBD-symptom agreement was perfect in 22% (n=8) of dyads. Twenty-five percent (n=9) of patients reported greater symptomology than parents. In contrast, parents reported greater symptom severity in the majority (53%, n=19) of parent-patient dyads. Linear regression analyses suggest that the magnitude of the total health score itself did not predict the presence and magnitude of parent-child dyadic agreement (t=-0.20, P=0.84). Bland-Altman plots (Figure 1) illustrate that patients and parents agreed most on presence of blood in stool and agreed least on the presence or absence of weight loss. Conclusion: While a percentage of parents and pediatric patients conceptualize their current IBD symptoms in a similar fashion, parent report often describes a symptomatic presentation that is more severe than the child's report herself. This finding is consistent with other research that suggests that parent report tends to portray symptoms that are more severe, either by frequency or subsequent impairment. Clinicians should be mindful of the manner by which choice of reporter may influence both the presentation and assessment of their pediatric patient. Future research should attempt to more clearly understand the etiology of this discordance and the possible implications and clinical consequences of its presence.
Sa1997 Identifying Fistulizing Crohn's Disease in a National Pediatric Inflammatory Bowel Disease Quality Improvement Collaborative Registry Jeremy Adler, Shiming Dong, Kevin Dombkowski Background: Perianal fistulas are a common complication of Crohn's disease (CD). Little population-based data are available to describe the epidemiology of fistulizing disease in pediatric CD. We sought to characterize the prevalence of fistulizing CD using in a large population of pediatric CD patients. Methods: We used the ImproveCareNow (ICN) Network registry of prospectively collected visit-level data to identify CD patients (May 2006-October 2014). ICN is a multicenter pediatric inflammatory bowel disease (IBD) quality improvement collaborative (65 sites contributed data). Clinicians document physical examination and Paris phenotype classification at each outpatient IBD visit. Fistula noted on exam and concomitant change in phenotype were used to corroborate time of new-onset perianal fistulas. Period prevalence of perianal fistulizing phenotype was determined by first occurrence of perianal fistula within the first 1- and 5-years after IBD diagnosis and was stratified by age, gender, race and geographic region. The prevalence was compared across groups (chi square). Results: The ICN registry included 10,969 patients (44% female); 7,076 (65%) were classified as having CD and 397 (5.6%) were excluded for missing/conflicting entries. Complete data were available for calculating period prevalence of perianal fistulizing phenotype within the first 1-year in 5,562 (83%) and 5-year in 2,170 (35%) patients (Table 1). Overall, 21% developed perianal fistula within 1-year and was identical among the 5-year prevalence group (21%). Males were more likely to develop a perianal fistula by 1-year (22% vs. 19%; p=0.02) and similarly by 5-years (p=0.07). There was no difference by age at time of IBD diagnosis for fistula development by 1-year (p=0.3), although by 5-years fistulas were more prevalent among those diagnosed between 6-10 years of age (p=0.04). Perianal fistula was most common among Blacks and least among Whites at 1-year (25% vs. 20%; p=0.08) and at 5-years (30% vs. 20%; p=0.02). Early onset CD (before age 10 years; Table 2) was most common in Asians (40%; p<0.001). Among early onset CD, the greatest prevalence of fistulas within the first year was seen in Blacks (32%; p=0.004). Regionally, the greatest prevalence of fistulas was found in the Northeast and least in the Midwest by 1-year (26% vs. 16%; p<0.001) and by 5-years (27% vs. 15%; p<0.001). Conclusions: In this large multicenter study of pediatric IBD, regional and racial differences in the development of perianal fistulas were found. Our findings indicate that perianal fistulas are common and occur early in pediatric CD. Consequently early therapy should be aimed at fistula prevention. These findings support the use of the ICN registry for conducting population-based studies and suggest that additional studies to evaluate comparative effectiveness of preventive therapies are warranted.
S-379
AGA Abstracts
AGA Abstracts
serious infections, including varicella and zoster. Additionally, this population remains underimmunized against varicella, and concerns exist regarding the safety and efficacy of this immunization in immunosuppressed patients. We aimed to evaluate the risk of varicellaand zoster-related hospitalization among children with IBD. Methods: A retrospective cohort study was performed utilizing data on varicella- and zoster-related hospitalizations from the 1997, 2000, 2003, 2006, 2009, and 2012 triennial Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID). Hospitalizations with a primary diagnosis of varicella or herpes zoster were compared between children (ages 5 to 21) with and without IBD using logistic regression. Results: There were 12,219,138 admissions in the HCUP-KID database from 1997-2012, including 4,434 with varicella and 4,488 with zoster listed as the primary diagnosis. Children with IBD accounted for 57 (1.29%) and 74 (1.64%) of the varicella- and zoster-related hospitalizations, respectively. Primary admissions for varicella or zoster accounted for 0.4% of all hospitalizations of children carrying a diagnosis of IBD. Compared to children without IBD, those with IBD were at significantly higher risk for varicella-related hospitalization (OR 4.98, 95% CI 3.84-6.47) and zoster-related hospitalization (OR 6.35, 95% CI 5.04-7.99). This risk was higher among children with Crohn's disease (varicella OR 6.22, 95% CI 4.65-8.32, zoster OR 7.39, 95% CI 5.67-9.65) compared to children with ulcerative colitis (varicella OR 2.69, 95% CI 1.50-4.81, zoster OR 4.34, 95% CI 2.75-6.85). Conclusion: Children with IBD are at increased risk for varicella- and zosterrelated hospitalization. These results highlight the importance of efforts to immunize IBD patients without a history of varicella disease or varicella immunization, ideally before the initiation of immunosuppressive therapy. Furthermore, research is needed on the safety and efficacy of varicella vaccine in children with IBD on immunomodulators including antitumor necrosis factor-alpha agents.