Prior, JA and Ranjbar, H and Belcher, J and Mackie, SL and Helliwell, T and Liddle, J and Mallen, CD (2017) Diagnostic delay for giant cell arteritis: a systematic review and meta-analysis. BMC Medicine, 15 (1). 120 -?. ISSN 1741-7015

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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.

Item Type: Article
Additional Information: This is the final published version of the article (version of record). It first appeared online via BioMed Central at http://dx.doi.org/10.1186/s12916-017-0871-z - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: diagnostic delay, giant cell arteritis, meta-analysis, systematic review
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 26 Sep 2017 10:55
Last Modified: 26 Sep 2017 10:55
URI: http://eprints.keele.ac.uk/id/eprint/4048

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