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The impact of temporal artery biopsy on surgical practice

View Article: PubMed Central - PubMed

ABSTRACT

Background: Giant cell arteritis (GCA) has the potential to cause irreversible blindness and stroke in affected patients [1–4]. Temporal artery biopsy (TAB) remains the gold standard test for GCA [6–8]. Recent literature suggests that TAB does not change management of patients with suspected GCA and that ultrasound scan (USS) may be sufficient enough alone to confirm the diagnosis [9–11,13]. The aim of this study is to therefore determine the impact of TAB on current surgical practice and emergency theatre services.

Materials and methods: A retrospective clinical study was performed of patients who had undergone TAB at the Caboolture Hospital from January 2010 to September 2015. Demographic and clinical data was collected from patient's medical records in regards to GCA.

Results: A total of 55 TAB were performed on 50 patients. Only two TAB were positive for GCA. Thirty-eight (76%) patients had a pre-TAB ACR criteria score of ≥3. Pre-operative corticosteroids were administered in forty-five (90%) patients, on average 4 ± 10 days pre-TAB. Mean time to TAB was 1.6 ± 1.6 days following their booking. Ninety-one percent of TAB were performed by surgical registrars. All TAB were performed using local anaesthesia alone.

Conclusions: TAB is an expensive procedure with a low positive yield. Recent evidence suggests promising results with USS in diagnosing GCA. With the exceedingly low positive TAB results found in this study, patients with suspected GCA should be investigated in accordance with the above algorithm. The routine use of USS will reduce the number of negative TAB performed.

No MeSH data available.


A proposed revised algorithm for investigating patients with suspected GCA.
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fig3: A proposed revised algorithm for investigating patients with suspected GCA.

Mentions: Previous studies have also mentioned the use of algorithms and incorporating the use of USS in these algorithms alongside TAB to help improve yield rates of TAB [16], [27]. A proposed revision of these algorithms and to include USS has been included in Fig. 3. This will hopefully be implemented in future practice in our institution.


The impact of temporal artery biopsy on surgical practice
A proposed revised algorithm for investigating patients with suspected GCA.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037119&req=5

fig3: A proposed revised algorithm for investigating patients with suspected GCA.
Mentions: Previous studies have also mentioned the use of algorithms and incorporating the use of USS in these algorithms alongside TAB to help improve yield rates of TAB [16], [27]. A proposed revision of these algorithms and to include USS has been included in Fig. 3. This will hopefully be implemented in future practice in our institution.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Giant cell arteritis (GCA) has the potential to cause irreversible blindness and stroke in affected patients [1–4]. Temporal artery biopsy (TAB) remains the gold standard test for GCA [6–8]. Recent literature suggests that TAB does not change management of patients with suspected GCA and that ultrasound scan (USS) may be sufficient enough alone to confirm the diagnosis [9–11,13]. The aim of this study is to therefore determine the impact of TAB on current surgical practice and emergency theatre services.

Materials and methods: A retrospective clinical study was performed of patients who had undergone TAB at the Caboolture Hospital from January 2010 to September 2015. Demographic and clinical data was collected from patient's medical records in regards to GCA.

Results: A total of 55 TAB were performed on 50 patients. Only two TAB were positive for GCA. Thirty-eight (76%) patients had a pre-TAB ACR criteria score of ≥3. Pre-operative corticosteroids were administered in forty-five (90%) patients, on average 4 ± 10 days pre-TAB. Mean time to TAB was 1.6 ± 1.6 days following their booking. Ninety-one percent of TAB were performed by surgical registrars. All TAB were performed using local anaesthesia alone.

Conclusions: TAB is an expensive procedure with a low positive yield. Recent evidence suggests promising results with USS in diagnosing GCA. With the exceedingly low positive TAB results found in this study, patients with suspected GCA should be investigated in accordance with the above algorithm. The routine use of USS will reduce the number of negative TAB performed.

No MeSH data available.