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Meta-Analysis
. 2017 Jun 28;15(1):120.
doi: 10.1186/s12916-017-0871-z.

Diagnostic delay for giant cell arteritis - a systematic review and meta-analysis

James A Prior  1 , Hoda Ranjbar  2 , John Belcher  2 , Sarah L Mackie  3   4 , Toby Helliwell  2 , Jennifer Liddle  2   5 , Christian D Mallen  2
Affiliations
Meta-Analysis

Diagnostic delay for giant cell arteritis - a systematic review and meta-analysis

James A Prior et al. BMC Med. .

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.

Keywords: Diagnostic delay; Giant cell arteritis; Meta-analysis; Systematic review.

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Figures

Fig. 1
Fig. 1
Selection of articles for inclusion in systematic review and meta-analysis
Fig. 2
Fig. 2
Meta-analysis of time-periods of delay in receiving a diagnosis of giant cell arteritis
Fig. 3
Fig. 3
Meta-analysis comparing delay in diagnosis between GCA with cranial or non-cranial characteristics
See this image and copyright information in PMC

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