TY - JOUR
T1 - Multivariable prediction model for suspected giant cell arteritis
T2 - Development and validation
AU - Ing, Edsel B.
AU - Luna, Gabriela Lahaie
AU - Toren, Andrew
AU - Ing, Royce
AU - Chen, John J.
AU - Arora, Nitika
AU - Torun, Nurhan
AU - Jakpor, Otana A.
AU - Alexander Fraser, J.
AU - Tyndel, Felix J.
AU - Sundaram, Arun N.E.
AU - Liu, Xinyang
AU - Lam, Cindy T.Y.
AU - Patel, Vivek
AU - Weis, Ezekiel
AU - Jordan, David
AU - Gilberg, Steven
AU - Pagnoux, Christian
AU - Ten Hove, Martin
N1 - Publisher Copyright:
© 2017 Ing et al.
PY - 2017/11/22
Y1 - 2017/11/22
N2 - Purpose: To develop and validate a diagnostic prediction model for patients with suspected giant cell arteritis (GCA). Methods: A retrospective review of records of consecutive adult patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at seven university centers. The pathologic diagnosis was considered the final diagnosis. The predictor variables were age, gender, new onset headache, clinical temporal artery abnormality, jaw claudication, ischemic vision loss (VL), diplopia, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet level. Multiple imputation was performed for missing data. Logistic regression was used to compare our models with the non-histologic American College of Rheumatology (ACR) GCA classification criteria. Internal validation was performed with 10-fold cross validation and bootstrap techniques. External validation was performed by geographic site. Results: There were 530 complete TABx records: 397 were negative and 133 positive for GCA. Age, jaw claudication, VL, platelets, and log CRP were statistically significant predictors of positive TABx, whereas ESR, gender, headache, and temporal artery abnormality were not. The parsimonious model had a cross-validated bootstrap area under the receiver operating characteristic curve (AUROC) of 0.810 (95% CI =0.766–0.854), geographic external validation AUROC’s in the range of 0.75-0.85, calibration pH–L of 0.812, sensitivity of 43.6%, and specificity of 95.2%, which outperformed the ACR criteria. Conclusion: Our prediction rule with calculator and nomogram aids in the triage of patients with suspected GCA and may decrease the need for TABx in select low-score at-risk subjects. However, misclassification remains a concern.
AB - Purpose: To develop and validate a diagnostic prediction model for patients with suspected giant cell arteritis (GCA). Methods: A retrospective review of records of consecutive adult patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at seven university centers. The pathologic diagnosis was considered the final diagnosis. The predictor variables were age, gender, new onset headache, clinical temporal artery abnormality, jaw claudication, ischemic vision loss (VL), diplopia, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet level. Multiple imputation was performed for missing data. Logistic regression was used to compare our models with the non-histologic American College of Rheumatology (ACR) GCA classification criteria. Internal validation was performed with 10-fold cross validation and bootstrap techniques. External validation was performed by geographic site. Results: There were 530 complete TABx records: 397 were negative and 133 positive for GCA. Age, jaw claudication, VL, platelets, and log CRP were statistically significant predictors of positive TABx, whereas ESR, gender, headache, and temporal artery abnormality were not. The parsimonious model had a cross-validated bootstrap area under the receiver operating characteristic curve (AUROC) of 0.810 (95% CI =0.766–0.854), geographic external validation AUROC’s in the range of 0.75-0.85, calibration pH–L of 0.812, sensitivity of 43.6%, and specificity of 95.2%, which outperformed the ACR criteria. Conclusion: Our prediction rule with calculator and nomogram aids in the triage of patients with suspected GCA and may decrease the need for TABx in select low-score at-risk subjects. However, misclassification remains a concern.
KW - Diagnosis
KW - Giant cell arteritis
KW - Nomogram
KW - Prediction rule
KW - Temporal artery biopsy
KW - Validation
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U2 - 10.2147/OPTH.S151385
DO - 10.2147/OPTH.S151385
M3 - Article
AN - SCOPUS:85035233438
SN - 1177-5467
VL - 11
SP - 2031
EP - 2042
JO - Clinical Ophthalmology
JF - Clinical Ophthalmology
ER -