Table 2.
Extent of diagnostic delay reported within articles included in systematic review (n = 22)
| Sex | Age | Reported diagnostic delay | Converted diagnostic delaya | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lead author, reference | Definition of GCA | n | % F | Mean | SD | Range | Time | Mean | SD | Range | Mean weeks of delay | SD |
| Calamia [25] | Positive TAB for GCA after fever was initial symptom | 15 | 66.7 | 67 | – | 57–75 | M | 3b | – | – | – | – |
| Bella Cueto [26] | Positive TAB for GCAc | 100 | 53 | 71.6 | – | 52–88 | D | 126 | – | 6–2190 | 18 | 52 |
| Karanjia [27] | Positive TAB for GCA and/or study defined clinical criteria | 63 | – | – | – | – | D | 52 | – | – | – | – |
| Desmet [28] | Positive TAB for GCA | 34 | 73.5 | 70.8 | – | 60–99 | – | – | – | – | – | – |
| Positive TAB for GCA, with cranial or polymyalgia symptomsc | 21 | – | – | – | – | D | 8.5 | 10.9 | 1–40 | 1.2 | 1.6 | |
| Positive TAB for GCA with constitutional (fever, fatigue, anorexia or weight loss) symptoms | 13 | – | – | – | – | D | 21.5 | 27.9 | 2–105 | 3.1 | 4.0 | |
| Kelkel [29] | Positive TAB for GCA and/or study defined clinical criteria | 130 | 74.6 | 76 | 7.5 | 60–92 | M | 5b | – | 0.5–48 | – | – |
| Myklebust [30] | Positive TAB for GCA, without PMRc | 39 | – | 70.4 | – | – | M | 1.5 | – | 0.25–7.0 | 6.4 | 7.2 |
| Positive TAB for GCA, with PMR | 15 | – | 74.4 | – | – | M | 1.9 | – | 0.5–5 | 8.1 | 10.7 | |
| Brack [31] | Large-vessel GCA (GCA diagnosis with vasculitic involvement) | 74 | 88 | 66 | – | 52–85 | M | 8.1 | – | 0.1–48.0 | 34.7 | 34.2 |
| Cranial GCA (Positive TAB)c | 74 | 78 | 72 | – | 54–89 | M | 2.6 | – | 0.5–11.0 | 11.1 | 7.5 | |
| Duhaut [32] | Incident cases of GCA, who satisfy inclusion criteria, including positive TABc | 207 | 75.8 | 75.6 (F) 74.1 (M) | 8 7.4 | – – | D | 48 | – | 5–2113 | 6.9 | 50.2 |
| Incident cases of GCA, who satisfy inclusion criteria, with negative TAB | 85 | 65.9 | 75.1 (F) 74.0 (M) | 7.8 8.6 | – – | D | 33 | – | 4 – 1096 | 4.7 | 26.0 | |
| Nesher [33] | GCA defined using 1990 ACR criteriac | 144 | 64.6 | 73.0 | – | – | M | 1.5 | – | 0.1–12 | 6.4 | 7.9 |
| Hu [34] | Positive TAB for GCA or on clinical grounds (response to steroids) | 16 | 6.3 | 43.1 | – | 28–60 | M | 5.5 | – | 0.25–24.3 | – | – |
| Liozon [11] | Positive TAB for GCAc | 175 | 64.6 | 75.2 | 7.1 | – | D | 79 | 83.5 | – | 11.3 | 11.9 |
| Silent GCA (constitutional symptoms, raised erythrocyte sedimentation rate) | 21 | 66.7 | 74.3 | 7.9 | – | D | 123 | – | 30 – 360 | 17.6 | 7.9 | |
| Overt cranial GCA | 130 | 63.8 | 75.6 | 6.9 | – | D | 70 | – | 4 – 350 | 10.0 | 8.2 | |
| Nuenninghoff [35] | GCA defined using 1990 ACR criteria | 168 | 79.2 | 75.6 | – | – | D | 40b | – | 21–89 | – | – |
| Gonzalez-Gay [36] | Positive TAB for GCA, with vascular involvementc | 199 | 52.8 | 74.6 | 7.0 | – | W | 9.8 | 10.8 | – | 9.8 | 10.8 |
| Positive TAB for GCA, without vascular involvement | 11 | 72.7 | 73.8 | 5.3 | – | W | 20.2 | 17.6 | – | 20.2 | 17.6 | |
| Pease [37] | GCA diagnosis (1990 ACR criteria) after initial presentation with polymyalgia symptomsc | 42 | – | 71 | – | 60–81 | M | 3.0 | – | 0.4 – 22.1 | 12.9 | 23.3 |
| Loddenkemper [38] | Positive TAB for GCA | 90 | 74.4 | 74.6 | 7.8 | – | D | 125b | – | 2–2555 | – | – |
| Mari [39] | Positive TAB for GCA and 3 or more 1990 ACR criteriac | 79 | 77.2 | 74.8 | – | 59–89 | D | 92 | – | 12 – 498 | 13.1 | 11.6 |
| Ezeonyeji [13] | GCA in medical recordsc | 65 | 72.3 | 75 | D | 35 | – | 2 – 336 | 5.0 | 11.9 | ||
| Mackie [40] | GCA with ischaemic manifestation (GCA defined by 1990 ACR criteria, positive TAB or clinical features)c | 222 | 71.0 | 72 | – | 67–78 | D | 64 | 98.3 | 12.3–78.5 | 9.1 | 14.0 |
| Czihal [41] | GCA in medical recordsc | 110 | 76.4 | 69 | 8.4 | – | W | 18.2 | 21.8 | – | 18.2 | 21.8 |
| Extra-cranial GCA | 59 | 83.1 | 62.5 | 7.6 | – | W | 28.7 | 25.1 | – | 28.7 | 25.1 | |
| Cranial GCA | 51 | 68.6 | 73.7 | 7.0 | – | W | 6.5 | 6.6 | – | 6.5 | 6.6 | |
| Prieto-Gonzalez [42] | Positive TAB for newly-diagnosed GCA and 1990 ACR classificationc | 40 | 67.5 | 79.0 | – | 57–92 | D | 74.2 | 90.5 | 5 – 365 | 10.6 | 12.9 |
| Patil [20] | Conventional pathway – GCA diagnosis in medical recordsc | 46 | 71.7 | 75.4 | 7.6 | – | D | 32.0 | 39.5 | 1–196 | 4.6 | 5.6 |
| Fast-track pathway – GCA based on clinical features, lab results, biopsy and response to steroids | 67 | 77.6 | 74.1 | 7.6 | – | D | 35.9 | 47.6 | 0–206 | 5.1 | 6.8 | |
| GCA patients (total)c | 204 | 79.9 | 76.0 | 8.2 | – | D | 41.3 | 95.5 | – | 5.9 | 13.6 | |
| Singh [43] | GCA without visual manifestation. Positive TAB for newly-diagnosed GCA and 1990 ACR classification | 157 | 81.0 | 75.6 | 7.8 | – | D | 44.5 | 107.3 | – | 6.4 | 15.3 |
| GCA with visual manifestation. Positive TAB for newly-diagnosed GCA and 1990 ACR classification | 47 | 77.0 | 77.4 | 9.2 | – | D | 30.6 | 31.1 | – | 4.4 | 4.4 | |
aIf the extent of diagnostic delay was reported as ‘days’ or ‘months’, this was converted to weeks
bMedian
cDataset used in meta-analysis
ACR American College of Rheumatology, GCA giant cell arteritis, TAB temporal artery biopsy, PMR polymyalgia rheumatica
Time: D days, W weeks, M months