Background:Giant cell arteritis (GCA) is the most frequently diagnosed vasculitis in Spain. The highest incidence recorded in the country is 17 new cases per 100,000 inhabitants/year. Its delayed diagnosis exposes the patient to an increased risk of multiple ischaemic complications. Among them, vision loss has been reported in up to 1 in 6 cases. Most of these patients, according to unpublished local observations, presented with headache, visual disturbances or polymyalgic symptoms to an emergency department facility and were not correctly or prompted diagnosed.Objectives:To determine the level of knowledge, skills and diagnostic and therapeutic competencies of the medical staff of multiple emergency departments in our city in regard to giant cell arteritis.Methods:We designed an observational study based on a single survey carried out between February and March 2020 to medical staff from 12 emergency departments in the city of Madrid. Four private and eight public emergency departments were deliberately included. The selection of the surveyed staff was randomly selected to reach 50% of the total number of physicians in each department. A total of 229 surveys were distributed by e-mail. A total of 125 physicians responded (final response rate 54.5%). Twenty-two physicians (9.2%) did not respond to the request and the rest declined to participate, although they responded to the demographic section (35.8%).The survey included the following sections: respondent profile, knowledge of epidemiological aspects, identification of clinical manifestations, diagnostic and therapeutic skills, and educational interest.Results:Forty respondents (33.6%) worked in a privately managed emergency department and 79 (66.4%) in a public centre.The mean age of respondents was 37.3 SD 5.9 years, and the proportion of women was 62.4%. Mean length of service was 3.4 SD 1.2 years among physicians in private emergency departments and 5.7 SD 2.3 in a public management unit. Sixty-four respondents (53.7%) were specialists in Family and Community Medicine, and 46 (38.6%) in internal medicine. No significant differences in demographic characteristics were identified between respondents who agreed to participate and those who declined.In regard to epidemiological knowledge, 50.6% of respondents were unable to identify the age group at highest risk of GCA, 32.7% did not recognise its predominance in the female sex, and 26% did not know the approximate incidence of the disease.In terms of diagnostic suspicion, 46.2% of respondents were able to identify at least five clinical manifestations of the disease. Elevated ESR, CRP and the presence of anaemia were recognised as positive analytical data by 98.3%, 85.7% and 57.7% of respondents, respectively. Ultrasonography of temporal arteries was identified by 97.5% of respondents as a useful diagnostic technique.One hundred and two respondents (81.6%) indicated that they had not suspected GCA in the last month. In the last year, 34 respondents (27.2%) reported having diagnosed the disease on at least one occasion. Regarding treatment, in cases of absence of ischaemic lesion 85.7% indicated suboptimal corticosteroid therapy guidelines, however, 63.0% of the respondents self-rated their therapeutic skills as very good or excellent.Finally, 88.2% of respondents expressed interest in participating in training programmes in diagnosis and treatment of GCA.Conclusion:There are important areas for improvement in knowledge, diagnostic skills and therapeutic competencies among emergency physicians in relation to the suspicion and management of GCA.Disclosure of Interests:None declared
Clinical Manifestations of Giant Cell Arteritis
