Understanding Referral and Diagnostic Pathways for Giant Cell Arteritis
Notice bibliographique
Résumé
Objectives Giant cell arteritis (GCA) is considered a rheumatologic emergency due to early risks of vision loss and stroke. At our center, there is currently no standard pathway for referral or diagnostic testing of GCA, which may result in diagnostic delays and/or unnecessary exposure to prednisone. The aim of this study was to better understand the pathways followed by patients referred for suspected GCA to identify barriers to care and areas for improvement. Methods Charts of patients referred to University of Alberta Rheumatology for query GCA between January 2022 and January 2024 were retrospectively reviewed. Second opinions and transfer of care referrals were excluded. Patient demographics, number of days between referral and first Rheumatology visit, types of diagnostic tests ordered (imaging, labs, biopsies), time to confirmation/exclusion of diagnosis of GCA (days) and cumulative exposure to prednisone until diagnosis determined (mg) were recorded. Data was analyzed using descriptive statistics. Results Of 779 patients with a triage diagnosis of vasculitis or polymyalgia rheumatica, 81 new referrals for query GCA were identified. Of these 81, 60 (74.1%) were women and mean age was 72.1 (±10.3) years. Most were referred by family medicine (36, 44.4%), ophthalmology (14, 17.3%), and emergency medicine (14, 17.3%). The median time between referral and first rheumatology visit was 9 (0-113) days. The most frequently ordered diagnostic test was temporal artery biopsy (66, 81% of patients), followed by PET scan (32, 39.5%), and temporal artery ultrasound (3, 3.7%). Ultimately, a diagnosis of GCA was made in 53 (65.4%) of referred patients [confirmed by either biopsy or imaging in 38 (47%) or clinically diagnosed in the absence of a positive test in 15 (18.5%)] and excluded in 28 (34.6%). The median time between Rheumatology referral to the result of first confirmatory test was 13 (3-529) days, and median time to exclusion of GCA diagnosis was 25 (0-189) days. Ultimately, 66 (81%) patients received prednisone while work-up was performed, with side effects reported in 42 (63.6%). The median cumulative prednisone exposure to those in whom GCA was ultimately excluded was 785 (0-4890) mg. Conclusion Of patients referred to rheumatology for suspected GCA, the diagnosis was confirmed by testing in 47%, made clinically in 18%, and excluded in 35%. There was wide variability in time to confirmation/exclusion of diagnosis, during which patients received large amounts of prednisone. These findings indicate the need for a standard referral/diagnostic pathway to expedite testing and reduce unnecessary exposure to high dose prednisone.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,015 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».