Background
Methods
Data sources, searches and study selection
Data extraction
Quality assessment
Data synthesis
Analysis
Results
Search results
Sample characteristics
Lead author, reference | Year | Sampling period | Country | Healthcare setting | Study design | Definition of delay in GCA diagnosis |
---|---|---|---|---|---|---|
Systematic review (n = 22) | ||||||
Calamia [25] | 1981 | 1976–1978 | USA | Tertiary care | Retrospective | Duration symptoms were present before diagnosis |
Bella Cuetoa [26] | 1985 | 1968–1983 | Spain | Secondary care | Retrospective | Duration of symptoms until diagnosis |
Karanjia [27] | 1989 | – | USA | Secondary care | Retrospective | Average delay from onset of symptom to biopsy |
Desmeta [28] | 1990 | 1982–1988 | Belgium | Secondary care | Retrospective | Time delay between presentation and biopsy |
Kelkel [29] | 1991 | 1984–1990 | Switzerland | Secondary care | Retrospective | From first signs or symptoms to beginning of treatment |
Myklebusta [30] | 1996 | 1987–1994 | Norway | Secondary care | Prospective | Delay of diagnosis |
Bracka [31] | 1999 | 1960–1996 | USA | Tertiary care | Retrospective | Time to diagnosis |
Duhauta [32] | 1999 | 1991–1997 | France | Secondary care | Prospective | Time interval between onset of symptoms and diagnosis |
Neshera [33] | 1999 | 1980–1995 | Israel | Secondary care | Retrospective | Time from onset of symptoms to diagnosis |
Hu [34] | 2002 | 1999–2001 | China | Secondary care | Prospective | Duration of symptoms before biopsy |
Liozona [11] | 2003 | 1977–2002 | France | Secondary care | Retrospective | Delay in diagnosis |
Nuenninghoff [35] | 2003 | 1950–1999 | USA | Primary & secondary | Retrospective | Time from onset of symptoms to GCA diagnosis |
Gonzalez-Gaya [36] | 2004 | 1981–2001 | Spain | Secondary care | Retrospective | Delay to diagnosis |
Peasea [37] | 2005 | – | England | Secondary care | Prospective | Time to presentation |
Loddenkemper [38] | 2007 | – | England | Secondary care | Retrospective | Onset of symptoms prior to admission |
Maria [39] | 2009 | 1989–2007 | Spain | Secondary care | Retrospective | Delay in diagnosis |
Ezeonyejia [13] | 2011 | 2003–2008 | England | Secondary care | Retrospective | Symptoms onset to diagnosis |
Mackiea [40] | 2011 | 2005–2009 | England | Secondary care | Retrospective | Time between first onset of symptoms and first steroid treatment |
Czihala [41] | 2012 | 2002–2010 | Germany | Secondary care | Retrospective | Time to diagnosis |
Prieto-Gonzaleza [42] | 2012 | 2006–2011 | Spain | Secondary care | Prospective | Duration of symptoms until diagnosis |
Patila [20] | 2015 | 2009–2013 | England | Secondary care | Prospective | Duration of symptom until diagnosis |
Singha [43] | 2015 | 1950–2004 | USA | Primary & secondary | Retrospective | Duration of symptoms |
Initially excluded articles, subsequently used for characteristic-specific analysis only (n = 6) | ||||||
Gonzalez-Gayb [45] | 2000 | 1981–1998 | Spain | Secondary care | Retrospective | Delay to diagnosis |
Schmidtb [46] | 2000 | 1996–1999 | Germany | Secondary care | Retrospective | Delay in therapy |
Gonzalez-Gay [47] | 2001 | 1981–1998 | Spain | Secondary care | Retrospective | Delay to diagnosis |
Gonzalez-Gay [48] | 2003 | 1981–2001 | Spain | Secondary care | Retrospective | Delay to diagnosis |
Gonzalez-Gayb [44] | 2005 | 1981–2004 | Spain | Secondary care | Retrospective | Delay to diagnosis |
Lopez-Diaz [49] | 2008 | 1981–2006 | Spain | Secondary care | Retrospective | Delay to diagnosis |
Diagnostic delay of GCA
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 |
GCA-specific characteristic diagnostic delay
Mean delay by category | |||||||
---|---|---|---|---|---|---|---|
Characteristics | Author | Year |
n
| Weeks (SD) |
n
| Weeks (SD) |
P valuea
|
Symptoms | |||||||
PMR | With | Without | |||||
Pease [37] | 2005 | 42 | 12.9 (23.3) | – | – | – | |
Ezeonyeji [13] | 2011 | 14 | 6.0 (1.8) | – | – | – | |
Visual manifestation | With | Without | |||||
Gonzalez-Gay [45] | 2000 | 42 | 9.6 (11.3) | 119 | 11.5 (12.5) | 0.19 | |
Ezeonyeji [13] | 2011 | 23 | 3.0 (2.9) | – | – | – | |
Singh [43] | 2015 | 47 | 4.4 (4.4) | 157 | 6.4 (15.3) | – | |
Visual loss | With | Without | |||||
Gonzalez-Gay [45] | 2000 | 24 | 10.8 (13.6) | 137 | 11.0 (12.1) | 0.48 | |
Schmidt [46] | 2000 | 5 | 7 (3) | – | – | – | |
Ezeonyeji [13] | 2011 | 16 | 1.7 (1.4) | – | – | – | |
Headache | Yes | No | |||||
Gonzalez-Gay [44] | 2005 | 203 | 9.2 (9.9) | 37 | 16.6 (15.0) | <0.001 | |
Ezeonyeji [13] | 2011 | 54 | 4.3 (3.9) | – | – | – | |
Jaw claudication | Yes | No | |||||
Ezeonyeji [13] | 2011 | 31 | 4.6 (2.8) | – | – | – | |
Scalp tenderness | Yes | No | |||||
Ezeonyeji [13] | 2011 | 27 | 4.0 (2.9) | – | – | – | |
GCA | |||||||
Cranial vs. non-cranial | Cranial | Non–cranial | |||||
Desmet [28] | 1990 | 21 | 1.2 (1.6) | 13 | 3.1 (4.0) | <0.05 | |
Brack [31] | 1999 | 74 | 11.1 (7.5) | 74 | 34.7 (34.2) | <0.001 | |
Liozon [11] | 2003 | 130 | 10.0 (8.2) | 21 | 17.6 (7.9) | 0.003 | |
Gonzalez-Gay [44] | 2005 | 199 | 9.8 (10.8) | 11 | 20.2 (17.6) | 0.003 | |
Ezeonyeji [13] | 2011 | – | – | 21 | 5.4 (3.5) | – | |
Czihal [41] | 2012 | 51 | 6.5 (6.6) | 59 | 28.7 (25.1) | <0.01 | |
GCA with PMR | GCA | GCA & PMR | |||||
Myklebust [30] | 1996 | 39 | 6.4 (7.2) | 15 | 8.1 (10.7) | – | |
Gonzalez-Gay [44] | 2005 | 144 | 8.3 (10.0) | 96 | 13.4 (12.2) | <0.001 | |
Biopsy result | Positive | Negative | |||||
Duhaut [32] | 1999 | 207 | 6.9 (50.2) | 85 | 4.7 (26.0) | – | |
Gonzalez-Gay [47] | 2001 | 161 | 7 (1.7) | 29 | 8 (4.0) | 0.6 | |
Demographic | |||||||
Age | <69 years | ≥70 years | |||||
Lopez-Diaz [49] | 2008 | 46 | 13.2 (12.8) | 227 | 9.4 (10.2) | 0.03 | |
Location | Rural | Urban | |||||
Gonzalez-Gay [48] | 2003 | 132 | 9.9 (11.7) | 78 | 11.1 (10.9) | 0.23 | |
Sex | Men | Women | |||||
Gonzalez-Gay [48] | 2003 | 97 | 9.7 (12.6) | 113 | 11.0 (10.4) | 0.20 |