Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis

Prior, James A.; Ranjbar, Hoda; Belcher, John; Mackie, Sarah L.; Helliwell, Toby; Liddle, Jennifer; Mallen, Christian D.

Abstract

BACKGROUND: Giant cell arteritis (GCA), if untreated, can lead to blindness and stroke. The study's objectives were to (1) determine a new evidence-based benchmark of the extent of diagnostic delay for GCA and (2) examine the role of GCA-specific characteristics on diagnostic delay. METHODS: Medical literature databases were searched from inception to November 2015. Articles were included if reporting a time-period of diagnostic delay between onset of GCA symptoms and diagnosis. Two reviewers assessed the quality of the final articles and extracted data from these. Random-effects meta-analysis was used to pool the mean time-period (95% confidence interval (CI)) between GCA symptom onset and diagnosis, and the delay observed for GCA-specific characteristics. Heterogeneity was assessed by I (2) and by 95% prediction interval (PI). RESULTS: Of 4128 articles initially identified, 16 provided data for meta-analysis. Mean diagnostic delay was 9.0 weeks (95% CI, 6.5 to 11.4) between symptom onset and GCA diagnosis (I (2)?=?96.0%; P?<?0.001; 95% PI, 0 to 19.2 weeks). Patients with a cranial presentation of GCA received a diagnosis after 7.7 (95% CI, 2.7 to 12.8) weeks (I (2)?=?98.4%; P?<?0.001; 95% PI, 0 to 27.6 weeks) and those with non-cranial GCA after 17.6 (95% CI, 9.7 to 25.5) weeks (I (2)?=?96.6%; P?<?0.001; 95% PI, 0 to 46.1 weeks). CONCLUSIONS: The mean delay from symptom onset to GCA diagnosis was 9 weeks, or longer when cranial symptoms were absent. Our research provides an evidence-based benchmark for diagnostic delay of GCA and supports the need for improved public awareness and fast-track diagnostic pathways.

Citation

Prior, J. A., Ranjbar, H., Belcher, J., Mackie, S. L., Helliwell, T., Liddle, J., & Mallen, C. D. (2017). Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis. BMC Medicine, 15, Article 120. https://doi.org/10.1186/s12916-017-0871-z

• Journal Article Type: Article
• Acceptance Date: May 9, 2017
• Publication Date: 2017-06
• Publicly Available Date: May 26, 2023
• Journal: BMC Medicine
• Electronic ISSN: 1741-7015
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Article Number: 120
• DOI: https://doi.org/10.1186/s12916-017-0871-z
• Keywords: diagnostic delay, giant cell arteritis, meta-analysis, systematic review
• Publisher URL: http://dx.doi.org/10.1186/s12916-017-0871-z