Description

Moudrous et al reported a model for the diagnosis of giant cell arteritis (GCA). This can help to identify a patient who may not require a temporal artery biopsy (TAB). The authors are from multiple institutions in The Netherlands.


Patient selection: age > 50 years, new onset headache or visual loss

 

Predictors of a positive temporal artery biopsy:

(1) weight loss (OR 52.9)

(2) positive halo sign (OR 7.0) on color duplex sonography

(3) thrombocytosis (OR 33.9)

(4) bilateral headache (OR 19.7)

 

total score =

= SUM(number of predictors present)

 

Number of Predictors

Positive TA Biopsy

Need for TA Biopsy

0

< 35%

yes

1

< 35%

yes

2

from 58-95%

yes

3

98-100%

no

4

98-100%

no

 

For combinations of 2 predictors

 

Predictor 1

Predictor 2

Positive TA Biopsy

weight loss

thrombocytosis

95%

weight loss

bilateral headache

91%

weight loss

halo

79%

thrombocytosis

bilateral headache

87%

halo

thrombocytosis

70%

halo

bilateral headache

58%

 

Additional factors to consider:

(1) elevated ESR

(2) elevated serum CRP

 

Performance:

• The area under the ROC curve is 0.93.


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