Giant Cell Arteritis Treated in a 'Fast Track' Approach may Reduce the Risk of Blindness

Of the patients evaluated by the ''fast track'' principle from March 2010 to December 2012, 11.1% had transient visual manifestations, and none went on to suffer from permanent visual loss.

GCA is a condition in which medium and large-size arteries, usually in the head and neck, become inflamed (sometimes referred to as temporal arteritis). Symptoms of GCA, which include aching and soreness in and around the temples, jaw pain while eating, and loss of vision, often develop suddenly. Permanent visual loss is one of the most serious complications of GCA; in one study, visual manifestations were reported in 26% of patients, and permanent visual loss in up to 15%.2

Speaking on behalf of the SONOVAS study group, Dr. Andreas P. Diamantopoulos from the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway said: "Giant cell arteritis should be regarded as a medical emergency because without prompt treatment it can lead to permanent blindness. Our data suggests that a fast-track approach significantly reduces this risk, encouraging findings that will now need to be confirmed in larger groups of patients."

This was in marked contrast to the results seen in the 28 patients who were traditionally evaluated between March 2010 and February 2012. In this group, visual disturbances were observed in seven patients, of whom six (21.5%) suffered from permanent vision loss in one or both eyes. The difference between the two groups with regard to permanent visual loss was statistically significant (p=0.035).

Patients suspected to have GCA were consecutively evaluated between March 2010 and December 2012 using colour Doppler ultrasound (CDUS). The ''fast- track'' principle (quick evaluation by CDUS within 24 hours, and immediate initiation of treatment if appropriate) was implemented in the outpatient clinic from March 2012.

During the evaluation period, a total of 46 patients were diagnosed with GCA. All of these patients fulfilled the ACR Classification Criteria for GCA* and produced a positive CDUS result of the temporal artery.

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Women With Severe Injuries are Less Likely Than Men to be Treated in a Trauma Center: Study

"Gender-based disparities in access to healthcare services in general have been recognized for some time and evidence is emerging that these disparities extend to the treatment of severe injuries in trauma centers," says lead author Andrea Hill. MSc, PhD, a post-doctoral fellow at Sunnybrook Health Sciences Centre and the University of Toronto in Ontario, Canada. "Our study confirms and expands on these earlier findings by evaluating the relationship between gender and trauma center care in a large cohort of patients from across Canada."

The study results will be presented at the ATS 2013 International Conference in Philadelphia.The retrospective cohort study included 98,871 adult patients with severe injury (Injury Severity Score>15 or death within 24 hours of hospital admission).Of the 33,080 women in the cohort, 49.6% received care in a trauma center, compared to 63.2% of males, a statistically significant (p<0.0001) difference. In the subgroup of patients aged 65 or older, 37.5% of women received trauma center care, compared with 49.6% of men, again a significant (p<0.0001) difference. After adjusting for the effects of clinical, demographic, and socioeconomic variables, severely injured womenremained less likely to be treated in a traumacenter than men (odds ratio 0.79, 95% confidence interval 0.76 - 0.82). Separate analyses of women with fall-related injuries and women with motor vehicle-related injuries revealed that they were also less likely to receive trauma center care than men. This pattern of gender differences in access to trauma center care was consistent across different mechanisms of injury, different income levels and among both urban and rural patients."Our study provides yet more evidence of important gender differences in access to trauma center care for people with severe injuries," said Dr. Hill. "Future research should focus on the factors underlying these differences and on the effects of these disparities on patient outcomes."

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