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The aim of this study was to identify red flags suggestive of CD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature review was conducted to identify symptoms associated with CD in patients presenting with PAA\/PAF. A questionnaire including those symptoms, supplemented with items from the International Organization for the Study of Inflammatory Bowel Diseases (IO-IBD) red flags index for luminal CD, was administered to all adult patients presenting with a PAF and eventually diagnosed with CD and matched patients (1:3) from the same study period with a cryptoglandular PAF (2012\u20132023) at a single non-academic teaching hospital. All patients were asked to recall symptoms\/signs experienced during their first PAF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The systematic review identified 8 articles reporting on 15 clinical characteristics in patients presenting with PAA (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092)\/PAF (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096), supplemented with 13 items from the IO-IBD red flags index (28 items in total). A total of 25 patients with CD and 75 patients with PAF without CD answered the questionnaire. Univariate analysis identified seven items associated with CD (age, family history,\u2009&gt;\u20092 perianal interventions, weight loss, abdominal pain, diarrhoea and fatigue), and four items remained significant in multivariate analysis: age (OR 3.4 [1.0\u201311.5]),\u2009&gt;\u20092 previous perianal interventions (OR 3.4 [1.0\u201310.1]), weight loss (OR 14.4 [3.7\u201355.6]) and abdominal pain (OR 9.8 [1.9\u201349.8]). Receiver-operating characteristic curve (ROC) analysis showed that a combination of these red flags was associated with good discrimination of CD versus non-CD (AUC 0.83 [0.72\u20130.94]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The perianal red flags index has a good predictive value for early identification of patients with PAF at risk for underlying CD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10151-024-03106-y","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T07:33:42Z","timestamp":1743406422000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Early diagnosis of Crohn\u2019s disease in patients presenting with a perianal fistula: systematic review and development of a perianal red flags index"],"prefix":"10.1007","volume":"29","author":[{"given":"L. 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