title: Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study.
abstract: OBJECTIVE
  To investigate the effectiveness of a fast track pathway (FTP) on sight loss in patients with suspected giant cell arteritis (GCA).
  
  
  METHODS
  A longitudinal observational cohort study was conducted in the secondary care rheumatology department. One hundred and thirty-five newly referred suspected GCA patients seen via the FTP (Jan. 2012-Dec. 2013) were compared to 81 patients seen through the conventional referral and review system (Jan. 2009-Dec. 2011).
  
  
  RESULTS
  The FTP resulted in significant reduction in irreversible sight loss from 37.0% (as seen in the historical cohort 2009-2011) to 9.0 % (2012-2013, OR 0.17, p=0.001). Adjustment for clinical and demographic parameters including known risk factors for GCA associated blindness did not significantly change the primary result (OR 0.08, p=0.001). FTP resulted in a reduction of time from symptom onset to diagnosis, particularly by reduction of time from general practitioner's (GP) referral to the rheumatology review (79% of FTP patients were seen within one working day compared to 64.6 % in the conventional pathway, p=0.023). The FTP has seen a reduction in number of GP appointments.
  
  
  CONCLUSIONS
  There was a significant reduction of permanent sight loss with a fast track GCA pathway. The effect may be due to multiple factors including better GP education and reduction in delayed diagnosis. These results need verification at other sites.
authors.affiliation: Southend University Hospital, Essex, UK; and Aditya Birla Memorial Hospital, Pune, India.
authors.forename: P
authors.initials: P
authors.lastname: Patil
authors.affiliation: Southend University Hospital, Essex, UK.
authors.forename: M
authors.initials: M
authors.lastname: Williams
authors.affiliation: Southend University Hospital, Essex, UK.
authors.forename: W W
authors.initials: WW
authors.lastname: Maw
authors.affiliation: Southend University Hospital, Essex, UK.
authors.forename: K
authors.initials: K
authors.lastname: Achilleos
authors.affiliation: Southend University Hospital, Essex, UK.
authors.forename: S
authors.initials: S
authors.lastname: Elsideeg
authors.affiliation: Southend University Hospital, Essex, UK, and Medical University Graz, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Dejaco
authors.affiliation: Southend University Hospital, Essex, UK.
authors.forename: F
authors.initials: F
authors.lastname: Borg
authors.affiliation: Castle Point and Rochford Clinical Commissioning Group, Essex, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Southend University Hospital, Essex, UK.
authors.forename: B
authors.initials: B
authors.lastname: Dasgupta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000209:etiology*; D015331:Cohort Studies; D019091:Critical Pathways; D057210:Delayed Diagnosis; D061345:Early Medical Intervention; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000473:pathology*; D061665:Time-to-Treatment
chemical_list: D005938:Glucocorticoids