(WHS-P1.04) IMPACT OF DIAGNOSTIC DELAY ON HEALING OUTCOMES AND HEALTHCARE UTILIZATION IN PATIENTS WITH PYODERMA GANGRENOSUM
Friday, May 17, 2024
10:30 AM – 11:30 AM East Coast USA Time
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis classically causing painful skin ulcerations with a large impact on quality of life. PG diagnosis is often challenging as the clinical presentation can mimic other ulcerative skin disorders with no specific biological marker. Misdiagnosis and delayed diagnosis can induce mismanagement. However, the impact of the delay of PG diagnosis on healing outcomes and subsequent healthcare utilization has not yet been studied and the purpose of our study was to determine this impact. We conducted a prospective study supplemented by retrospective data for 100 patients with ulcerative PG from the Oregon Health and Science University Pyoderma Gangrenosum Study patient registry. Prospective data included healing time and hospitalizations while ulcer onset, date of diagnosis, and emergency room (ER) visits were collected retrospectively. Total healing time was defined from the date of diagnosis to wound closure. The patients were divided between a delay of diagnosis ≤3 months and >3 months based on the definition of a chronic wound. Healing time was evaluated with a Kaplan-Meier analysis. Twenty-six percent of patients had a diagnostic delay of ≤3 months. The average ulcer size (available for 84% of patients) was 56cm2 (95% CI 10 to 103) for ≤3 months and 71cm2 (95% CI 50 to 92) for >3 months diagnostic delay. The average pain in a numeric rating scale was 3.6 and 4.4 out of 10 for each group respectively (p=0.213). There was a statistically significant difference in median time to healing between the groups: 14.0 months (95% CI 9.4 to 26.6) with a delay of diagnosis ≤3 months and 21.7 months (95% CI 10.2 to 62.9) with a delay of diagnosis >3 months (log-rank P = 0.014). The difference in number of ER visits was also statistically significant with a mean of 0.5 visits for a delay of diagnosis ≤3 months and 1.5 visits for a delay of diagnosis >3 months (P = 0.038). Moreover, the number of hospitalizations was significantly higher for patients with a diagnostic delay >3 months [2.3 hospitalizations versus 1.4 hospitalizations (P = 0.034)]. Our study demonstrated that a delay of PG diagnosis >3 months by medical providers prolongs healing time and significantly increases the number of ER visits and hospitalizations. As a result, delayed diagnosis may lead to higher costs and an increased burden on the healthcare system influencing treatment time and treatment costs for patients. Given average pain is similar in both groups, patients with a longer disease course as a result of delayed diagnosis have prolonged suffering. Delayed healing time could also lead to increased time lost from work. In conclusion, this study clearly shows the negative consequences of a delayed PG diagnosis supporting why it is paramount to increase awareness of this underdiagnosed disease among medical providers and the necessity of specific markers to aid in a timely diagnosis.