Analysis of an acute care surgery service performing temporal artery biopsy for suspected giant cell arteritis

Temporal artery biopsy (TAB) for suspected giant cell arteritis (GCA) represents an infrequent but important inpatient consultation for acute care surgery (ACS) services. Given the morbidity associated with delayed treatment, corticosteroids are often initiated before biopsy, raising questions about the diagnostic utility and impact of TAB in contemporary practice. We performed a review of all inpatient TABs completed by an ACS service at a tertiary center between March 2015 and January 2024 to characterize case volume, pathology results, and influence of biopsy findings on corticosteroid management. Sixty-four patients underwent TAB, the majority of whom were elderly and female, with visual symptoms and headache being the most common presenting complaints. Nearly all patients were initiated on high-dose corticosteroids prior to biopsy, with a median of two days between ACS consultation and procedure. Pathologic findings confirmed GCA in 10% of cases, with additional biopsies demonstrating intimal fibroplasia or equivocal inflammatory changes. Despite widespread steroid initiation, biopsy results influenced discharge management, as patients with negative pathology were more likely to undergo corticosteroid tapering prior to or shortly after discharge. The median American College of Rheumatology 1990 classification score was three, with just over half of patients meeting criteria for GCA. No TABs were performed during 2020, but biopsy volume increased substantially in the post-COVID period. These findings suggest that ACS services play an important role in the diagnostic evaluation of suspected GCA. Although corticosteroid therapy is frequently initiated prior to biopsy, TAB continues to yield clinically meaningful information that informs subsequent management decisions.