Table 2.
Diagnostic accuracy of symptoms and physical signs. CI, confidence interval; TA, Takayasu arteritis; Se, sensitivity; Sp, specificity; PLR, positive likelihood ratio; NLR, negative likelihood ratio.
| Symptoms and physical signs | Number of studies | Number of TAK cases | Number of comparators | Se (95% CI) | Sp (95% CI) | PLR (95% CI) | NLR (95% CI) |
|---|---|---|---|---|---|---|---|
| Vascular | |||||||
| Decreased or absent pulse [29–31, 33, 35, 36, 38–40, 42] | 10 | 1279 | 2336 | 57.1 (43.9–69.3) | 91.6 (74.5–97.6) | 8.15 (2.35–22.2) | 0.48 (0.35–0.62) |
| Vascular bruits [16, 29–31, 33, 36, 38–41] | 10 | 1598 | 2603 | 57.9 (44.5–70.2) | 92.6 (78.3–97.7) | 9.00 (2.94–22.4) | 0.46 (0.34–0.59) |
| Blood pressure asymmetry [16, 30, 32, 33, 35, 38, 39, 41, 42] | 9 | 1497 | 2473 | 53.0 (43.2–62.5) | 93.8 (85.3–97.5) | 9.53 (3.43–21.9) | 0.51 (0.40–0.63) |
| Hypertension [29, 31, 32, 35, 36, 38, 40, 42] | 8 | 877 | 608 | 41.1 (30.9–52.2) | 58.4 (39.6–75.0) | 1.01 (0.78–1.01) | 1.03 (0.86–1.29) |
| Arm claudication [16, 30, 32, 35, 38, 39, 42] | 7 | 1338 | 1568 | 32.3 (22.1–47.8) | 91.3 (76.6–97.4) | 4.35 (1.34–11.2) | 0.75 (0.61–0.91) |
| Leg claudication [16, 30, 32, 35, 38, 39, 42] | 7 | 1337 | 1568 | 14.9 (10.2–21.0) | 90.1 (83.7–94.1) | 1.61 (0.71–3.19) | 0.95 (0.85–1.05) |
| Claudication [30, 31, 33, 36, 40, 41] | 6 | 526 | 2195 | 26.2 (15.7–40.3) | 93.9 (80.8–98.2) | 5.5 (1.1–17.4) | 0.79 (0.63–0.98) |
| Carotidynia/neck pain [29, 36, 38, 40, 42] | 5 | 602 | 349 | 10.5 (6.7–16.2) | 97.2 (90.1–99.3) | 4.54 (1.21–12.3) | 0.92 (0.87–0.98) |
| Abdominal bruit [30, 32, 35, 42] | 4 | 360 | 765 | 37.9 (20.4–59.3) | 89.1 (69.8–96.7) | 4.52 (0.89–14.5) | 0.71 (0.44–1.04) |
| Carotid artery with reduced pulse or tenderness [16, 29, 39, 41] | 4 | 951 | 706 | 26.9 (13.5–46.3) | 96.2 (93.7–97.7) | 7.23 (3.64–12.5) | 0.75 (0.56–0.89) |
| Chest pain [16, 36, 38, 39] | 4 | 1098 | 750 | 12.4 (6.0–23.9) | 95.3 (87.4–98.3) | 2.89 (1.06–6.5) | 0.91 (0.82–0.99) |
| Myocardial infarction [34, 39, 40, 42] | 4 | 491 | 295 | 5.5 (2.4–12.5) | 96.5 (82.1–99.4) | 2.79 (0.22–12.7) | 0.99 (0.90–1.16) |
| Pulse deficit in arm [16, 30, 32, 41] | 4 | 689 | 1270 | 58.5 (43.5–72.0) | 83.2 (47.3–96.5) | 4.75 (1.09–16.3) | 0.54 (0.33–0.91) |
| Amaurosis [32, 36, 40] | 3 | 265 | 328 | 6.20 (1.90–18.6) | 94.5 (87.7–97.7) | 1.57 (0.22–5.51) | 0.99 (0.85–1.10) |
| Aortic valve murmur [29, 30, 34] | 3 | 181 | 769 | 18.7 (8.7–35.6) | 95.0 (92.2–96.9) | 4.25 (1.27–10.1) | 0.85 (0.67–0.98) |
| Blindnessa [32, 34, 40] | 3 | 149 | 218 | 2.0 (0.4–10.8) | 94.1 (81.1–98.3) | 0.79 (0.03–4.3) | 1.05 (0.92–1.22) |
| Blurred vision [32, 36, 42] | 3 | 284 | 196 | 7.8 (5.1–11.6) | 91.2 (64.1–98.4) | 1.36 (0.19–5.35) | 1.05 (0.92–1.45) |
| Jaw claudicationa [32, 34, 40] | 3 | 149 | 218 | 2.7 (0.8–9.2) | 79.8 (62.5–90.3) | 0.15 (0.05–0.35) | 1.24 (1.09–1.5) |
| Stroke [32, 39, 42] | 3 | 484 | 215 | 9.9 (7.5–12.9) | 94.0 (85.6–97.6) | 1.85 (0.64–4.34) | 0.97 (0.91–1.06) |
| Stroke or transient ischemic attacka [32, 35, 40] | 3 | 231 | 316 | 9.4 (6.0–14.2) | 95.5 (26.0–97.3) | 2.2 (1.08–4.09) | 0.95 (0.90–1.0) |
| Subclavian artery bruit [30, 32, 35] | 3 | 248 | 711 | 38.0 (14.0–69.8) | 89.8 (62.5–97.9) | 5.66 (0.62–23.0) | 0.71 (0.33–1.18) |
| Other | |||||||
| Headache [30–32, 34–40, 42] | 11 | 1193 | 1469 | 28.8 (21.7–37.2) | 63.0 (48.1–75.8) | 0.80 (0.53–1.21) | 1.15 (0.93–1.47) |
| Fever [32, 33, 35–42] | 10 | 1156 | 1794 | 23.4 (15.3–34.2) | 76.9 (64.3–84.7) | 1.04 (0.65–1.60) | 1.00 (0.87–1.16) |
| Arthralgia [32, 33, 36, 38, 39] | 5 | 766 | 1373 | 15.0 (7.3–28.4) | 65.9 (43.3–83.1) | 0.46 (0.29–0.68) | 1.32 (1.09–1.75) |
| Weight loss [35, 36, 38, 39, 42] | 5 | 817 | 415 | 18.7 (11.1–29.7) | 81.5 (62.4–92.1) | 1.09 (0.52–2.15) | 1.01 (0.87–1.25) |
| Abdominal pain [33, 38, 39] | 3 | 592 | 1205 | 13.3 (1.80–56.6) | 77.0 (36.0–95.2) | 0.78 (0.11–2.55) | 1.16 (0.69–1.98) |
| Faintness [33, 38, 39] | 3 | 592 | 1205 | 30.5 (6.4–73.7) | 87.4 (40.5–98.6) | 2.78 (1.0–7.27) | 0.8 (0.5–1.0) |
| Myalgia [32, 33, 39] | 3 | 461 | 1134 | 12.7 (3.2–39.0) | 69.7 (54.9–81.4) | 0.51 (0.10–1.42) | 1.24 (0.86–1.62) |
| Oral ulcerb [33, 36, 38] | 3 | 392 | 1186 | 4.8 (2.1–10.6) | 71.0 (4.7–99.2) | 0.29 (0.07–1.12) | 1.07 (0.91–1.26) |
aFor these signs, all comparators had giant cell arteritis.
bPLR and NLR were estimated using a univariate random effect logistic regression to maintain consistency when only a limited number of studies were available.