E157 From referral to diagnosis, a critical look at the giant cell arteritis fast track pathway at Royal Wolverhampton Hospital NHS Trust

Abstract Background/Aims Timely diagnosis and initiation of treatment in giant cell arteritis (GCA) are critical in improving patient outcomes. The British Society for Rheumatology (BSR) provided guidelines outlining the recommended approach to assessing, diagnosing and managing patients with suspected GCA. Various GCA probability scores (GCAPSs) have emerged as a tool to triage GCA referrals. Methods This audit included patients referred to the Rheumatology Hot GCA Clinic at the Royal Wolverhampton Hospital (RWH) with suspected GCA between January 2024 and December 2024. Data were collected retrospectively from the institution’s electronic clinical portal. Southend GCAPSs were calculated utilising this information. The primary objective evaluated the performance of the RWH GCA fast-track pathway against the 2020 BSR guidelines, which served as the audit standard. The secondary objective outlined the potential utility of GCAPSs. Results In total 78 patients (26 males and 52 females; mean age of 64.9±13.4) were referred to the Hot GCA Clinic during the audit period. The audit standard compliance rates for specialist review within 3 days was 83%, for appropriate investigations conducted was 100%, and for glucocorticoid initiation on the same day was 67%. Temporal artery ultrasound (TA-USS) was undertaken in 59 patients, median wait was 1 day from date of appointment. GCA was diagnosed in 10 (13%) patients (5 males and 5 females; mean age of 76.3±8.4). Of these, 6 had positive TA-USS findings, 1 was diagnosed with ocular involvement by ophthalmology, and 3 were diagnosed based on clinical and biochemical findings. Among GCA patients, compliance with recommended supportive measures was suboptimal for blood glucose assessment (0%), providing written information was 30% and for providing information on red flag symptoms was 30%. In total, 26 patients had GCAPSs ≥9, with GCAPSs ≥9 yielding a sensitivity of 100% and specificity of 74.2% for diagnosing GCA. The area under the receiving operating characteristic (AUROC) (for GCAPSs ≥9) was 0.9468. The mean GCAPSs for GCA patients was 12.4±2.0. In this cohort, after adjusting for blood tests and ethnicity using binary logistic regression, GCAPSs are significantly associated with a diagnosis of GCA (OR = 3.27, 95% CI 1.45-7.368, p = 0.004). Conclusion This audit highlights the efficiency of our centre’s GCA fast-track pathway, with most patients receiving TA-USS within one working day. The audit identified areas for improvement, particularly in delivery of patient education and co-morbidity assessment (e.g. blood glucose monitoring). We recommend integrating standardised checklists or electronic prompts into clinical workflows to improve compliance with these measures. GCAPSs ≥9 identified all GCA cases, and the GCA cohort demonstrated statistically higher mean scores. This suggests GCAPSs’ potential as a triage tool for risk stratification, prioritising clinical reviews, diagnostics and early glucocorticoid treatment for high-risk patients. Further research is warranted to validate and operationalise GCAPSs in GCA assessment. Disclosure S. Pramanik: None. H. Sapkota: None.