title: Audit of the management of suspected giant cell arteritis in a large teaching hospital.
abstract: BACKGROUND
  The diagnosis of giant cell arteritis (GCA) is often confirmed by an early temporal artery (TA) biopsy of adequate length. Treatment of this condition with high-dose corticosteroids may be associated with significant morbidity, including osteoporosis.
  
  
  OBJECTIVE
  To audit current management of patients with suspected GCA at Auckland Healthcare, a large teaching hospital.
  
  
  METHODS
  We performed a retrospective chart review of all TA biopsies from January 1996 to June 2000. A total of 117 biopsies from 111 patients was audited. Of these patients, 37/111 (33%) had a final clinical diagnosis of GCA (GCA patients). The areas of interest for audit were waiting time for TA biopsy, length of sample, initial corticosteroid therapy and osteoporosis prophylaxis.
  
  
  RESULTS
  The mean waiting time for biopsy for all patients was 5.6 days (range 0-42 days). This time varied from 9.3 days for rheumatology patients to 2.6 days for ophthalmology patients (P = 0.003). Only 44/117 (37.6%) specimens measured more than 10 mm. For GCA patients, the median initial oral prednisone dose was 60 mg/day. Osteoporosis prophylaxis was prescribed in 24/37 (65%) GCA patients, most commonly cyclical etidronate.
  
  
  CONCLUSIONS
  There is significant variation in the management of GCA within our institution. This audit has highlighted several areas where improvement could be made, particularly in streamlining the process of obtaining TA biopsy and in promoting the use of osteoporosis prophylaxis.
authors.affiliation: Auckland Healthcare, University of Auckland, New Zealand. nicola.dalbeth@imm.ox.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Dalbeth
authors.forename: N
authors.initials: N
authors.lastname: Lynch
authors.forename: L
authors.initials: L
authors.lastname: McLean
authors.forename: F
authors.initials: F
authors.lastname: McQueen
authors.forename: J
authors.initials: J
authors.lastname: Zwi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D013700:Giant Cell Arteritis / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008775:Methylprednisolone / Q000009:adverse effects; D008875:Middle Aged; D009520:New Zealand; D010024:Osteoporosis / Q000139:chemically induced / Q000517:prevention & control*; D011241:Prednisone / Q000009:adverse effects; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000473:pathology
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone; D008775:Methylprednisolone