Management of suspected temporal arteritis. A decision analysis.
Management strategies for suspected temporal arteritis range from bilateral temporal artery biopsy to empiric corticosteroid therapy. A decision analysis of the clinical situation was constructed, and a sensitivity analysis for varying prevalences of temporal arteritis was used to calculate costs for different management strategies. Conclusions suggested by the analysis include the following: (1) due to the high cost of blindness, suspicion of disease must be low (less than 1.4%) not to biopsy; (2) at high suspicion of disease (greater than 30%), empiric steroids are the cheapest management; (3) when diagnostic procedures are indicated, bilateral biopsy is the cheapest initial diagnostic procedure; and (4) if unilateral biopsy is negative, a second biopsy is always cost effective.
D001706:Biopsy; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D013700:Giant Cell Arteritis / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D013699:Temporal Arteries / Q000473:pathology