A sinister needle in an enormous haystack: A clinician survey regarding Acute Aortic Syndrome diagnostic practice in United Kingdom Emergency Departments

McLatchie, Rachel; Gupta, Aakash; Wilson, Sarah; Reed, Matthew J; Group, Aortic Dissection Diagnosis in ED Research

doi:10.4081/ecj.2022.10758

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…The ADvISED study 24 (a multicentre observational study) prospectively assessed the performance of ADD-RS ≤1 plus D dimer <500 ng/mL and reported a sensitivity of 98.8% (96.4-99.7%) with a specificity of 57.3%. This is not currently widely adopted into UK Emergency Medicine practice, 26 but subject to validation, may play an important role in improving our ability to select the correct patients to scan.…”

Section: Discussionmentioning

confidence: 99%

Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis

et al. 2023

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Objectives: To understand why the diagnosis of AAS is missed in the ED, and to characterise the presenting features of cases in which a diagnosis of AAS was missed. Methods: A retrospective case series cohort study was performed, identifying and analysing cases where AAS was misdiagnosed in three UK EDs between 1st January 2011 and 31st December 2020. Results: 43 cases were included, 22 of which were type A aortic dissections. The most common incorrect presumed diagnoses made were acute coronary syndrome (28%), pulmonary embolism (12%) and ‘non-specific chest pain’ (12%). In 31 cases (72%) there was no evidence from the notes that the clinician had considered AAS in the differential diagnosis. In 10 cases (23%), AAS was considered, but the clinician was falsely reassured by atypical or resolved symptoms, clinical examination, or normal chest x-ray. Conclusions: ED clinicians may miss AAS by not considering it as a possibility, being falsely reassured by atypical or resolved symptoms, or mistaking it for other more common conditions. Further prospective work is necessary to establish the role of diagnostic aids and biomarkers in UK EDs.

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Section: Discussionmentioning

confidence: 99%

Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis

et al. 2023

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Diagnosis and management of acute aortic dissection in the emergency department

Reed

2024

Br J Hosp Med

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Acute aortic dissection is often misdiagnosed as a result of its atypical presentations. It affects 4000 patients a year in the UK of all ages, not just older patients, with increasing numbers of cases expected in the future because of the ageing population. Dissection of the aortic wall leads to sudden, severe pain, and commonly end-organ symptoms which must be recognised. Acute aortic dissection can be challenging to diagnose in the emergency department because of the multitude of possible presentations and the need for selective testing with Computed Tomography Angiography (CTA). Clinicians often miss acute aortic dissection because it is not considered in the differential diagnosis, and the challenge lies in identifying acute aortic dissection in a sea of complaints of chest, back and abdominal pain. There are several ways to improve diagnosis, including awareness campaigns, better education about patients in which to consider acute aortic dissection, and improved detection strategies including which patients should receive CTA. Clinical decision tools and biomarkers could help, but further research is required and is a research focus in emergency medicine. Once diagnosed, blood pressure control, analgesia and urgent surgery or transfer to enable this to occur with minimal delay is required.

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A sinister needle in an enormous haystack: A clinician survey regarding Acute Aortic Syndrome diagnostic practice in United Kingdom Emergency Departments

Cited by 2 publications

References 6 publications

Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis

Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis

Diagnosis and management of acute aortic dissection in the emergency department

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