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Whitfield E, White B, Denaxas S, Lyratzopoulos G. Diagnostic windows in non-neoplastic diseases: a systematic review. Br J Gen Pract 2023; 73:e702-e709. [PMID: 37308303 PMCID: PMC10285689 DOI: 10.3399/bjgp.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/28/2023] [Accepted: 04/04/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Investigating changes in prediagnostic healthcare utilisation can help identify how much earlier conditions could be diagnosed. Such 'diagnostic windows' are established for cancer but remain relatively unexplored for non-neoplastic conditions. AIM To extract evidence on the presence and length of diagnostic windows for non-neoplastic conditions. DESIGN AND SETTING A systematic review of studies of prediagnostic healthcare utilisation was carried out. METHOD A search strategy was developed to identify relevant studies from PubMed and Connected Papers. Data were extracted on prediagnostic healthcare use, and evidence of diagnostic window presence and length was assessed. RESULTS Of 4340 studies screened, 27 were included, covering 17 non-neoplastic conditions, including both chronic (for example, Parkinson's disease) and acute conditions (for example, stroke). Prediagnostic healthcare events included primary care encounters and presentations with relevant symptoms. For 10 conditions, sufficient evidence to determine diagnostic window presence and length was available, ranging from 28 days (herpes simplex encephalitis) to 9 years (ulcerative colitis). For the remaining conditions, diagnostic windows were likely to be present, but insufficient study duration was often a barrier to robustly determining their length, meaning that diagnostic window length may exceed 10 years for coeliac disease, for example. CONCLUSION Evidence of changing healthcare use before diagnosis exists for many non-neoplastic conditions, establishing that early diagnosis is possible, in principle. In particular, some conditions may be detectable many years earlier than they are currently diagnosed. Further research is required to accurately estimate diagnostic windows and to determine how much earlier diagnosis may be possible, and how this might be achieved.
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Affiliation(s)
- Emma Whitfield
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London, and Institute of Health Informatics, UCL, London
| | - Becky White
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London
| | - Spiros Denaxas
- Institute of Health Informatics, UCL, London; associate director, British Heart Foundation Data Science Centre, London; Health Data Research UK, London, and UCL Hospitals Biomedical Research Centre, London
| | - Georgios Lyratzopoulos
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London
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Kim S, Johnson SM, Lopez E, Stack T, Lamb MM, Zeatoun AL, Mohammad I, Alicea Delgado D, Norris M, Klatt-Cromwell C, Thorp B, Ebert CS, Senior BA, Kimple AJ. Granulomatosis With Polyangiitis Presenting as an Infratemporal Fossa Mass. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231161982. [PMID: 36993782 PMCID: PMC10041614 DOI: 10.1177/11795476231161982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 03/31/2023]
Abstract
Granulomatosis with polyangiitis is a rare autoimmune disease that affects small to medium-sized blood vessels throughout the body. Here, we present a case of an infratemporal mass that was the result of granulomatosis with polyangiitis. A 51-year-old male presented to the emergency department due to right cheek and facial pain that he had been experiencing for 2 to 3 months. An MRI revealed a mass within the right infratemporal and pterygopalatine fossae extending into the inferior right orbital fissure along the maxillary division of the trigeminal nerve (V2) and the vidian nerve causing concern for malignancy. Histology from an endoscopic biopsy demonstrated multiple arteries with luminal obliteration with non-necrotizing granulomas. The patient was started on steroids and immunosuppressive therapy, which improved his symptoms and decreased the size of the residual mass. This case illustrates the need for laboratory testing, imaging, and biopsy of the involved tissue in cases where GPA is suspected to prevent treatment delays that could lead to the destruction of vital organs.
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Affiliation(s)
- Sulgi Kim
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven M Johnson
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Erin Lopez
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Taylor Stack
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Meredith M Lamb
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Abdullah L Zeatoun
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ibtisam Mohammad
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Alicea Delgado
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Meghan Norris
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christine Klatt-Cromwell
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian Thorp
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles S Ebert
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brent A Senior
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam J Kimple
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Adam J Kimple, The University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician’s Office Building Room G-190, Chapel Hill, NC 27599, USA.
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Abstract
The many forms of vasculitis are characterized by inflammation of blood vessels, leading to potentially long-term sequelae including vision loss, aneurysm formation and kidney failure. Accurate estimation of the incidence and prevalence has been hampered by the absence of reliable diagnostic criteria and the rarity of these conditions; however, much progress has been made over the past two decades, although data are still lacking from many parts of the world including the Indian subcontinent, China, Africa and South America. Giant cell arteritis occurs in those aged 50 years and over and seems to mainly affect persons of northern European ancestry, whereas Takayasu arteritis occurs mainly in those aged under 40 years. By contrast, Kawasaki disease mainly occurs in children aged under 5 years and is most common in children of Asian ancestry, and IgA vasculitis occurs in children and adolescents. Although much less common than giant cell arteritis, the different forms of antineutrophil cytoplasmic antibody-associated vasculitis are being increasingly recognized in most populations and occur more frequently with increasing age. Behçet syndrome occurs most commonly along the ancient silk road between Europe and China. Much work needs to be done to better understand the influence of ethnicity, geographical location, environment and social factors on the development of vasculitis.
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Affiliation(s)
- Richard A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Gulen Hatemi
- Department of Internal Medicine, Division of Rheumatology and Behçet's Disease Research Centre, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Aladdin J Mohammad
- Department of Clinical Sciences, Division of Rheumatology, Lund University and Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
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4
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Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168435. [PMID: 34444182 PMCID: PMC8391274 DOI: 10.3390/ijerph18168435] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023]
Abstract
Diagnosis is one of the crucial tasks performed by primary care physicians; however, primary care is at high risk of diagnostic errors due to the characteristics and uncertainties associated with the field. Prevention of diagnostic errors in primary care requires urgent action, and one of the possible methods is the use of health information technology. Its modes such as clinical decision support systems (CDSS) have been demonstrated to improve the quality of care in a variety of medical settings, including hospitals and primary care centers, though its usefulness in the diagnostic domain is still unknown. We conducted a scoping review to confirm the usefulness of the CDSS in the diagnostic domain in primary care and to identify areas that need to be explored. Search terms were chosen to cover the three dimensions of interest: decision support systems, diagnosis, and primary care. A total of 26 studies were included in the review. As a result, we found that the CDSS and reminder tools have significant effects on screening for common chronic diseases; however, the CDSS has not yet been fully validated for the diagnosis of acute and uncommon chronic diseases. Moreover, there were few studies involving non-physicians.
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Affiliation(s)
- Robert W Hunter
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Tariq E Farrah
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Peter J Gallacher
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- GP trainee, South-East Scotland GP Programme, NHS Education for Scotland
| | - Neeraj Dhaun
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Rolle N, Muruganandam M, Jan I, Harji FM, Harrington J, Konstantinov KN. Look granulomatosis with polyangiitis (GPA) straight in the face: missed opportunities leading to a delayed diagnosis. AUTOIMMUNITY HIGHLIGHTS 2020; 10:8. [PMID: 32257064 PMCID: PMC7065353 DOI: 10.1186/s13317-019-0118-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/29/2019] [Indexed: 11/18/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is a systemic vasculitis with a potential to involve any organ system. It remains an important cause of kidney related morbidity and mortality. Early diagnosis can be difficult and requires high index of suspicion in all patients, but especially in cases with atypical presentation. We report a case with GPA, which was diagnosed only after new and advancing symptoms belied the original diagnosis of bilateral facial palsy and aortic mural thrombus.
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Affiliation(s)
- N Rolle
- 1Department of Medicine, Division of Rheumatology, University of New Mexico School of Medicine, Albuquerque, NM 87131 USA
| | - M Muruganandam
- 1Department of Medicine, Division of Rheumatology, University of New Mexico School of Medicine, Albuquerque, NM 87131 USA
| | - I Jan
- Section of Rheumatology, Raymond G. Murphy Veterans Affairs Medical Center, 1501 San Pedro SE, Albuquerque, NM 87108 USA
| | - F M Harji
- Section of Rheumatology, Raymond G. Murphy Veterans Affairs Medical Center, 1501 San Pedro SE, Albuquerque, NM 87108 USA
| | - J Harrington
- 1Department of Medicine, Division of Rheumatology, University of New Mexico School of Medicine, Albuquerque, NM 87131 USA.,Section of Rheumatology, Raymond G. Murphy Veterans Affairs Medical Center, 1501 San Pedro SE, Albuquerque, NM 87108 USA
| | - K N Konstantinov
- 1Department of Medicine, Division of Rheumatology, University of New Mexico School of Medicine, Albuquerque, NM 87131 USA.,Section of Rheumatology, Raymond G. Murphy Veterans Affairs Medical Center, 1501 San Pedro SE, Albuquerque, NM 87108 USA
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Kataria S, Ravindran V. Emerging role of eHealth in the identification of very early inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2019; 33:101429. [PMID: 31810541 DOI: 10.1016/j.berh.2019.101429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Digital health or eHealth technologies, notably pervasive computing, robotics, big-data, wearable devices, machine learning, and artificial intelligence (AI), have opened unprecedented opportunities as to how the diseases are diagnosed and managed with active patient engagement. Patient-related data have provided insights (real world data) into understanding the disease processes. Advanced analytics have refined these insights further to draw dynamic algorithms aiding clinicians in making more accurate diagnosis with the help of machine learning. AI is another tool, which, although is still in the evolution stage, has the potential to help identify early signs even before the clinical features are apparent. The evolving digital developments pose challenges on allowing access to health-related data for further research but, at the same time, protecting each patient's privacy. This review focuses on the recent technological advances and their applications and highlights the immense potential to enable early diagnosis of rheumatological diseases.
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Strawberry gingivitis: Challenges in the diagnosis of granulomatosis with polyangiitis on gingival specimens. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:e202-e207. [DOI: 10.1016/j.oooo.2019.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/10/2019] [Accepted: 07/21/2019] [Indexed: 11/22/2022]
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Pearce F, Lanyon PC, Watts RA. Can prediction models in primary care enable earlier diagnosis of rare rheumatic diseases? Rheumatology (Oxford) 2018; 57:2065-2066. [PMID: 29462470 DOI: 10.1093/rheumatology/kex508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fiona Pearce
- Division of Epidemiology and Public Health, Department of Rheumatology, University of Nottingham, Nottingham, UK
| | - Peter C Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham NHS Treatment Centre, Nottingham, UK
| | - Richard A Watts
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Norwich Medical School, University of East Anglia and Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, UK
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