Probability-based algorithm using ultrasound and additional tests for suspected GCA in a fast-track clinic
Alwin Sebastian1, Alessandro Tomelleri1,2, Abdul Kayani1
1Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK.
RMD Open
|September 30, 2020
Summary
A new algorithm using the Southend pretest probability score (PTPS) effectively triages patients with suspected giant cell arteritis (GCA). This approach improves diagnostic accuracy and streamlines investigations, enhancing the utility of ultrasound (US) in GCA diagnosis.
Area of Science:
- Rheumatology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Giant cell arteritis (GCA) presents with diverse clinical symptoms, necessitating accurate and timely diagnosis to rule out mimics.
- Urgent referrals for suspected GCA require a robust diagnostic process to ensure appropriate management.
- Current diagnostic pathways may lack efficiency in stratifying patients and guiding investigations.
Purpose of the Study:
- To develop an integrated, end-to-end algorithmic process for the rapid confirmation or exclusion of giant cell arteritis (GCA).
- To establish a probability score triage system to guide subsequent investigations, including ultrasound (US).
- To enhance the diagnostic performance of US in suspected GCA cases.
Main Methods:
- Development of a fast-track algorithm stratifying patients into low-risk (LRC), intermediate-risk (IRC), and high-risk (HRC) categories based on the Southend pretest probability score (PTPS).
- Retrospective analysis of case records for patients referred with suspected GCA.
- Assessment of the algorithm's diagnostic performance, particularly the role of US, in a cohort of referrals from 2018-2019.
Main Results:
- The algorithm categorized 354 referrals: LRC (151), IRC (137), and HRC (66), with 89 confirmed GCA cases.
- Ultrasound (US) demonstrated high diagnostic performance: overall sensitivity 97%, specificity 97%, and accuracy 97%.
- In the HRC group, US sensitivity was 94% and specificity 85%; in the IRC group, sensitivity was 100% and specificity 97%; in the LRC group, specificity was 98%.
Conclusions:
- The Southend PTPS algorithm effectively stratifies fast-track referrals for suspected GCA and aids in excluding alternative diagnoses.
- The algorithm enhances the interpretation of US findings within the clinical context, clarifying the diagnostic approach.
- Integration of PTPS with US significantly improves diagnostic test performance and identifies patients requiring further evaluation.
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