A Diagnostic Algorithm Based on a Simple Clinical Prediction Rule for the Diagnosis of Cranial Giant Cell Arteritis

Overview

Journal J Clin Med

Specialty General Medicine

Date 2021 Apr 3

PMID 33802092

Citations 3

Authors

Michael Czihal

Christian Lottspeich

Christoph Bernau

Teresa Henke

Ilaria Prearo

Marc Mackert

Siegfried Priglinger

Claudia Dechant

Hendrik Schulze-Koops

Ulrich Hoffmann

Affiliations

Soon will be listed here.

Abstract

Background: Risk stratification based on pre-test probability may improve the diagnostic accuracy of temporal artery high-resolution compression sonography (hrTCS) in the diagnostic workup of cranial giant cell arteritis (cGCA).

Methods: A logistic regression model with candidate items was derived from a cohort of patients with suspected cGCA ( = 87). The diagnostic accuracy of the model was tested in the derivation cohort and in an independent validation cohort ( = 114) by receiver operator characteristics (ROC) analysis. The clinical items were composed of a clinical prediction rule, integrated into a stepwise diagnostic algorithm together with C-reactive protein (CRP) values and hrTCS values.

Results: The model consisted of four clinical variables (age > 70, headache, jaw claudication, and anterior ischemic optic neuropathy). The diagnostic accuracy of the model for discrimination of patients with and without a final clinical diagnosis of cGCA was excellent in both cohorts (area under the curve (AUC) 0.96 and AUC 0.92, respectively). The diagnostic algorithm improved the positive predictive value of hrCTS substantially. Within the algorithm, 32.8% of patients (derivation cohort) and 49.1% (validation cohort) would not have been tested by hrTCS. None of these patients had a final diagnosis of cGCA.

Conclusion: A diagnostic algorithm based on a clinical prediction rule improves the diagnostic accuracy of hrTCS.

Citing Articles

Giant cell temporal arteritis: a clinicopathological study with emphasis on unnecessary biopsy.

Alkatan H, AlMana F, Maktabi A Front Ophthalmol (Lausanne). 2024; 3:1327420.

PMID: 38983072 PMC: 11182246. DOI: 10.3389/fopht.2023.1327420.

Hyperechogenic intimal lesions and wall thickness of the temporal and facial arteries in elderly patients with arterial occlusions of the eye.

Czihal M, Kohler A, Prearo I, Hoffmann U, Schulze-Koops H, Dechant C RMD Open. 2021; 7(3).

PMID: 34544823 PMC: 8454441. DOI: 10.1136/rmdopen-2021-001688.

Imaging Tests in the Early Diagnosis of Giant Cell Arteritis.

Prieto-Pena D, Castaneda S, Martinez-Rodriguez I, Atienza-Mateo B, Blanco R, Gonzalez-Gay M J Clin Med. 2021; 10(16).

PMID: 34442002 PMC: 8397068. DOI: 10.3390/jcm10163704.

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