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Diagnosis of Graves' orbitopathy (DiaGO): results of a pilot study to assess the utility of an office tool for practicing endocrinologists

Mitchell, Anna L., Goss, Linda, Mathiopoulou, Lemonia, Morris, Margaret, Vaidya, Bijay, Dickinson, A. Jane, Quinn, Anthony, Dayan, Colin Mark, McLaren, Julie, Hickey, Janis L., Lazarus, John Henry, Rose, Geoffrey E., Foley, Peter, MacEwen, Caroline J. and Perros, Petros 2015. Diagnosis of Graves' orbitopathy (DiaGO): results of a pilot study to assess the utility of an office tool for practicing endocrinologists. Journal of Clinical Endocrinology & Metabolism 100 (3) , E458-E462. 10.1210/jc.2014-3146

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Abstract

Context:In active Graves' orbitopathy (GO), treatment can improve the final cosmetic and visual outcome. Diagnostic delay results in significant morbidity and increases patient dissatisfaction. However, it can be challenging for endocrinologists to recognize GO and decide who should be referred for ophthalmic care. Objective:DiaGO, a clinical assessment tool, was developed for use in patients with Graves' disease (GD). The tool is designed to alert clinicians to the possibility of GO and prompt early ophthalmic assessment. Design and setting:A 20-point assessment tool was devised and tested on 104 GD patients: 27 “positive controls” with GO and 77 people with GD attending endocrine clinics over 17 months. Those scoring positively in endocrine clinics were referred for ophthalmic assessment. Both the appropriateness of the referral and subsequent treatment were assessed. Results:Eighty-eight of the 104 patients (85%) were female (mean age, 48.5 y; range, 18–76 y). All 27 “controls” scored positively. Of the 77 people evaluated with GD, 27 (35%) scored above the threshold for referral and GO was confirmed in 24/26 (92%) who attended for specialist ophthalmic assessment. Twelve of these 24 (50%) were offered specific treatment following ophthalmology review. Conclusions:The timely diagnosis of GO is important because early intervention in active disease can improve prognosis. DiaGO alerts clinicians to the possibility of GO and prompts referral to specialist ophthalmic care. It is quick and easy to use and does not require specialist ophthalmic skills. Overall, half of those referred after use of DiaGO were offered specific treatment, suggesting its use might significantly improve the management of patients.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Publisher: The Endocrine Society
ISSN: 0021-972X
Date of Acceptance: 2 December 2014
Last Modified: 11 Jun 2019 12:39
URI: http://orca.cf.ac.uk/id/eprint/84811

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