Factors associated with delays in the diagnosis of childhood onset uveitis: findings from a nation-wide cohort study.

Abstract

We investigated factors associated with delayed diagnosis of childhood onset uveitis. Prospective Cohort: United Kingdom Uveitis in Childhood National Inception Cohort (UNICORN) Study SUBJECTS: Children (aged <18 years) newly diagnosed with non-infectious uveitis between 1^st March 2020 and 28^th February 2023. Descriptive analysis of disease onset and presentation, with linear and logistic regression modelling to identify factors independently associated with increased time from onset to diagnosis (symptomatic disease) and structural complications at diagnosis (all cases). Among 221 children (median age, 10.9 years; 52% girls), the majority, 69%, were diagnosed following symptomatic onset, most commonly with redness, pain, or photophobia. Median time from symptom onset to diagnosis was 9 days (range, 0-568), with 50% having at least one complication at presentation with symptomatic onset. Independent predictors of increased time to diagnosis, following adjustment for the COVID-19 pandemic 'lockdown' period were bilateral disease (adjusted coefficient 38.1 days, 95% confidence 8.7 to 67.6, p=0.01) and initial presentation to primary care versus eye services (62.6, 13.7 to 111.5, p=0.01). Structural complications at diagnosis were independently associated with younger age (odds ratio 1.4, 1.3 to 1.7, p<0.001) and socioeconomic deprivation (4.5 for lowest quintile, 1.5 to 13.2, p<0.01). Delays in diagnosis occur in childhood uveitis of symptomatic onset, with symptoms being prevalent in disease. Improved awareness of this blinding disorder among primary-care practitioners, standardized referral pathways for childhood eye complaints, and equitable access to eye services are needed to prevent childhood onset, life-long visual disability.