Incidence of acute type A aortic dissection in emergency departments

Abstract

Due to the symptoms, patients with acute type A aortic dissection are first seen by the ambulance service and diagnosed at the emergency department. How often an aortic dissection occurs in an emergency department per year has been studied. The incidence in the emergency department may be used as a quality marker of differential diagnostics of acute chest pain. A multi-institutional retrospective study with the municipal Berlin hospital chain Vivantes and its Department of Pathology and the Charité - University Medicine Berlin was performed. From the Berlin Hospital Society, the annual numbers of publicly insured emergency patients were obtained. Between 2006 and 2016, 631 aortic dissections were identified. The total number of patients treated in the emergency departments (n = 12,790,577) was used to calculate the “emergency department incidence.” The autopsy data from six clinics allowed an estimate on how many acute type A aortic dissections remained undetected. Across all Berlin hospitals, the emergency department incidence of acute type A aortic dissection was 5.24 cases in 100,000 patients per year. In tertiary referral hospitals and, particularly, in university hospitals the respective incidences were markedly higher (6.7 and 12.4, respectively). Based on the autopsy results, about 50% of the acute type A aortic dissection may remain undetected, which would double the reported incidences. Among different hospital types the emergency department incidences of acute type A aortic dissection vary between 5.93/100,000 and 24.92/100,000. Aortic dissection; Incidence; Emergency Department; Epidemiology

Incidence and Mortality Rates of Thoracic Aortic Dissection in Korea – Inferred from the Nationwide Health Insurance Claims

“… 1 2 4 5 In a rare previous Asian nationwide population-based study, Yeh et al 12 demonstrated that the annual incidence rate of AD was 5.6 per 100,000 person-years, and that the average annual incidence of patients treated surgically for type A AD was 1.44 per 100,000 person-years in Taiwan. Additionally, in a recent German multi-institutional retrospective study, Wundram et al 15 demonstrated that the emergency department incidence of acute type A AD was 5.24 per 100,000 person-years. However, this group only investigated the prevalence rate and did not address the treatment outcomes.…”

Cocaine-Related Aortic Dissection: what do we know?

“…Because concurrent cocaine use is a relatively rare feature among all aortic dissection cases, patients could be misdiagnosed due to cardiovascular genesis being more likely associated to cocaine use [ 4 ] . In the history-taking setting of a patient with acute chest pain in the emergency room, the use of drugs should be included in the differential diagnostic considerations and the diagnosis of acute aortic dissection should be considered [ 8 , 24 , 25 ] .…”

“…In the International Registry of Acute Aortic Dissection (IRAD), cocaine use was reported in 1.8% of all cases [ 6 ] . Acute type A aortic dissection occurs at a population-based incidence ranging from 2.1 to 16.3 per 100.000 persons [ 7 , 8 ] . The European Union had about 513.5 million inhabitants in 2019.…”

Management of Aortic Root in Type A Dissection: Bentall Approach

“…Acute type A aortic dissection (ATAAD) is one of the most dramatic life-threatening diseases with an incidence that may be significantly higher than previously assumed based on previous retrospective studies [1][2][3][4][5]. This is underlined by the fact that up to one-half of ATAAD cases are detected only at autopsy [5].…”

“…Acute type A aortic dissection (ATAAD) is one of the most dramatic life-threatening diseases with an incidence that may be significantly higher than previously assumed based on previous retrospective studies [1][2][3][4][5]. This is underlined by the fact that up to one-half of ATAAD cases are detected only at autopsy [5]. Accumulation of experience, development of diagnostic tools, and improved treatment strategies have resulted in improved results of surgical treatment over time: according to International Registry of Aortic Dissection (IRAD), operative mortality dropped over time from 25 to 18% [6].…”