E158 A closed cycle audit of assessment of suspected giant cell arteritis at North Middlesex University Hospital

Abstract Background/Aims Giant cell arteritis (GCA) is an inflammatory disease affecting large vessels. It is treated as a medical emergency due to potentially severe consequences such as blindness. The purpose of this audit was to measure and improve adherence to BSR and GIRFT guidelines for GCA assessment and management at North Middlesex Hospital, a district general hospital in London. Methods Data were collected retrospectively from patients assessed in the Same Day Emergency Care, an ambulatory care clinic accepting referrals from general practice and the emergency department over a 12-month period and reaudited over a 4-month period. Patients coded with a suspected or confirmed diagnosis of GCA were included. Data on steroid treatment, rheumatology referral, ophthalmology assessment, ultrasound, laboratory investigations and clinical assessment were collected. After the first cycle, interventions were implemented by creating a trust guideline for a pathway in SDEC and creating a more streamlined order for temporal artery ultrasound on the IT system. Local teaching on GCA was also implemented with an information poster outlining the pathway in clinic rooms. The Southend GCA probability score was implemented for risk stratification purposes and evaluated using logistic regression models and receiver operating curve analysis. Statistical testing was carried out using R with chi-squared testing for categorical variables and Cox regression for time-to-event analysis. Results 46 patients were identified during the first cycle and 15 in the second, mean age was 67 and 64, respectively. A greater proportion of patients were treated with steroids in the second cohort (34% to 54%), although the time taken to initiate steroids remains the same (median 0 days). A greater proportion of patients were referred to rheumatology for assessment in the second cycle (55% to 77%); however, the time taken for rheumatology assessment from presentation was not significantly different (1 to 1.5 days). A greater proportion of patients were referred to ophthalmology in the second audit and time until assessment in the eye clinic was shorter (median 2 days to 1 day). There was a significant increase in the proportion of patients assessed with temporal artery ultrasound after the interventions (15% to 77%, p 0.001). A greater proportion of patients were assessed with CRP levels (92% to 100%). A GCA probability score of more than 12 points was found to have an area under the receiver operating curve of 0.978 in the combined total across both cohorts. Conclusion Following the introduction of a pathway and teaching on GCA improvements in assessment with ultrasound and in the eye clinic were demonstrated. A GCA probability score 12 was sensitive and specific for GCA and warrants empirical treatment with steroids, as demonstrated in other studies. Disclosure R. Ark: None. K. Fardeen: None. A. MacBrayne: None.