Management of the Patient with Suspected Temporal ArteritisA Decision-Analytic Approach

Niederkohr, Ryan D.; Levin, Leonard A.

doi:10.1016/j.ophtha.2005.01.031

Cited by 84 publications

(58 citation statements)

References 108 publications

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“…The development of the economic model structure was informed by evidence from published research on GCA in order to understand the main complications of the disease and steroid-related side effects. This was supplemented with evidence from previous economic and decision-analytic studies of GCA 78,79 and an analysis of outcomes and cost-effectiveness of a fast-track service for GCA. 80 …”

Section: Methodsmentioning

confidence: 99%

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The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Luqmani

Lee

Singh

et al. 2016

Health Technol Assess

385

404

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Background Giant cell arteritis (GCA) is a relatively common form of primary systemic vasculitis, which, if left untreated, can lead to permanent sight loss. We compared ultrasound as an alternative diagnostic test with temporal artery biopsy, which may be negative in 9–61% of true cases. Objective To compare the clinical effectiveness and cost-effectiveness of ultrasound with biopsy in diagnosing patients with suspected GCA. Design Prospective multicentre cohort study. Setting Secondary care. Participants A total of 381 patients referred with newly suspected GCA. Main outcome measures Sensitivity, specificity and cost-effectiveness of ultrasound compared with biopsy or ultrasound combined with biopsy for diagnosing GCA and interobserver reliability in interpreting scan or biopsy findings. Results We developed and implemented an ultrasound training programme for diagnosing suspected GCA. We recruited 430 patients with suspected GCA. We analysed 381 patients who underwent both ultrasound and biopsy within 10 days of starting treatment for suspected GCA and who attended a follow-up assessment (median age 71.1 years; 72% female). The sensitivity of biopsy was 39% [95% confidence interval (CI) 33% to 46%], which was significantly lower than previously reported and inferior to ultrasound (54%, 95% CI 48% to 60%); the specificity of biopsy (100%, 95% CI 97% to 100%) was superior to ultrasound (81%, 95% CI 73% to 88%). If we scanned all suspected patients and performed biopsies only on negative cases, sensitivity increased to 65% and specificity was maintained at 81%, reducing the need for biopsies by 43%. Strategies combining clinical judgement (clinician’s assessment at 2 weeks) with the tests showed sensitivity and specificity of 91% and 81%, respectively, for biopsy and 93% and 77%, respectively, for ultrasound; cost-effectiveness (incremental net monetary benefit) was £485 per patient in favour of ultrasound with both cost savings and a small health gain. Inter-rater analysis revealed moderate agreement among sonographers (intraclass correlation coefficient 0.61, 95% CI 0.48 to 0.75), similar to pathologists (0.62, 95% CI 0.49 to 0.76). Limitations There is no independent gold standard diagnosis for GCA. The reference diagnosis used to determine accuracy was based on classification criteria for GCA that include clinical features at presentation and biopsy results. Conclusion We have demonstrated the feasibility of providing training in ultrasound for the diagnosis of GCA. Our results indicate better sensitivity but poorer specificity of ultrasound compared with biopsy and suggest some scope for reducing the role of biopsy. The moderate interobserver agreement for both ultrasound and biopsy indicates scope for improving assessment and reporting of test results and challenges the assumption that a positive biopsy always represents GCA. Future work Further research should address the issue of an independent reference diagnosis, standards for interpreting and reporting test results and the evaluation of ultrasound training, and should also explore the acceptability of these new diagnostic strategies in GCA. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Methodsmentioning

confidence: 99%

“…78 For the many other common and mild AEs, for example moon face (round, puffy-shaped swollen face), there is likely to be a very small cost burden to the NHS. However, collectively there is a significant impact on quality of life; therefore, an overall adjustment to quality of life was applied (see Chapter 7, Health utilities).…”

Section: Other Adverse Eventsmentioning

confidence: 99%

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Luqmani

Lee

Singh

et al. 2016

Health Technol Assess

385

404

View full text Add to dashboard Cite

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“…Patients with initial negative biopsies who were later diagnosed with GCA accounted for 19% of all negative biopsies in one ESR erythrocyte sedimentation rate series; older age, headache, and thrombocytosis were more common in that group [49]. High-dose corticosteroid treatment (intravenous methylprednisolone or oral prednisone, 100 mg daily) must be initiated immediately, especially if the patient has amaurosis fugax or evidence of visual loss [50]. The eyes are often involved sequentially, and prompt treatment usually prevents second eye involvement.…”

Section: Giant Cell Arteritismentioning

confidence: 99%

Headache Attributable to Disorders of the Eye

Friedman

Gordon

Quirós

2010

Curr Pain Headache Rep

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Sensory innervation to the eye and periocular area arises from the ophthalmic branch of the trigeminal nerve. Thus, ocular, orbital, and systemic disorders may produce head pain with ocular signs and symptoms. Whereas some of these entities have characteristic diagnostic features, others mimic primary headache disorders such as migraine and cluster headache. This article reviews common ocular and neuro-ophthalmic conditions that are accompanied by pain in or near the eye.

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“…Nevertheless, most studies have been conducted with conventional bio-statistical approaches. Accordingly, scientists have turned to exploit advanced machine learning and/or data mining approaches to extract valuable clues hidden in large medical and clinical databases (Himes et al 2009;Lancashire et al 2005;Li et al 2004;Niederkohr and Levin 2005). For example, the Bayesian network has been exploited to identify the co-morbidity between chronic obstructive pulmonary disease and asthma (Himes et al 2009).…”

Section: Introductionmentioning

confidence: 99%

“…For example, the Bayesian network has been exploited to identify the co-morbidity between chronic obstructive pulmonary disease and asthma (Himes et al 2009). Furthermore, the decision tree algorithm has been exploited to guide diagnostic interpretation and therapeutic options for temporal arteritis (Niederkohr and Levin 2005).…”

Section: Introductionmentioning

confidence: 99%

Application of density estimation algorithms in analyzing co-morbidities of migraine

Yang

Oyang

Fuh

2011

2011 IEEE International Conference on Bioinformatics and Biomedicine Workshops (BIBMW)

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In this study, we will propose a density estimation based data analysis procedure to investigate the co-morbid associations between migraine and the suspected diseases. The primary objective of this study has aimed to develop a novel analysis procedure that can discover insightful knowledge from large medical databases. The entire analysis procedure consists of two stages. During the first stage, a kernel density estimation algorithm named relaxed variable kernel density estimation (RVKDE) is invoked to identify the samples of interest. Then, in the second stage, a density estimation algorithm based on generalized Gaussian components and named G 2 DE is invoked to provide a summarized description of the distribution. The results obtained by applying the proposed twostaged procedure to analyze co-morbidities of migraine revealed that the proposed procedure could effectively identify a number of clusters of samples with distinctive characteristics. The results further revealed that the distinctive characteristics of the clusters extracted by the proposed procedure were in conformity with the observations reported in recently published articles. Accordingly, it is conceivable that the proposed analysis procedure can be exploited to provide valuable clues of pathogenesis and facilitate development of proper treatment strategies.

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Management of the Patient with Suspected Temporal ArteritisA Decision-Analytic Approach

Cited by 84 publications

References 108 publications

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Headache Attributable to Disorders of the Eye

Application of density estimation algorithms in analyzing co-morbidities of migraine

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