Medikolegale Aspekte des präklinischen Managements von „akuten Aortensyndromen“

Kurz, Sabine; Falk, Volkmar; Buschmann, C.; Peters, M.

doi:10.1055/a-1075-1868

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Classifying patient treatment as an emergency until definitive care is reached can lead to prioritisation in disposition management and thus further reduce treatment time until treatment. 26 The Berlin STEMO concept 27 and the Aortentelefon in Berlin 12 serve as excellent examples of structured approaches to preclinical processes leading to improved patient outcomes, with similar observations noted in the UK. 28 29 Volume factor Beyond PCT, the quality and expertise of surgical intervention may significantly impact survival.…”

Section: Impact Of Delaymentioning

confidence: 87%

Modelling years of life lost due to acute type A aortic dissection in the German healthcare setting: a predictive study

Schiele,

König,

Meyer

et al. 2024

BMJ Open

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ObjectivesThis study aimed to develop a patient-centred approach to the burden of acute type A aortic dissection (ATAAD) through modelling. The main objective was to identify potential improvements in managing this life-threatening cardiovascular condition and to provide evidence-based recommendations to optimise outcomes.DesignWe developed a predictive model along patient pathways to estimate the burden of ATAAD through the years of life lost (YLLs) metric. The model was created based on a systematic review of the literature and was parameterised using demographic data from the German healthcare environment. The model was designed to allow interactive simulation of different scenarios resulting from changes in key impact factors.SettingThe study was conducted using data from the German healthcare environment and results from the literature review.ParticipantsThe study included a comprehensive modelling of ATAAD cases in Germany but did not directly involve participants.InterventionsThere were no specific interventions applied in this study based on the modelling design.Primary and secondary outcome measuresThe single outcome measure was the estimation of YLL due to ATAAD in Germany.ResultsOur model estimated 102 791 YLL per year for ATAAD in Germany, with 62 432 and 40 359 YLL for men and women, respectively. Modelling an improved care setting yielded 93 191 YLL or 9.3% less YLL compared with the current standard while a worst-case scenario resulted in 113 023 or 10.0% more YLL. The model is accessible athttps://acuteaorticdissection.com/to estimate custom scenarios.ConclusionsOur study provides an evidence-based approach to estimating the burden of ATAAD and identifying potential improvements in the management of pathways. This approach can be used by healthcare decision-makers to inform policy changes aimed at optimising patient outcomes. By considering patient-centred approaches in any healthcare environment, the model has the potential to improve efficient care for patients suffering from ATAAD.

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Section: Impact Of Delaymentioning

confidence: 87%

Modelling years of life lost due to acute type A aortic dissection in the German healthcare setting: a predictive study

Schiele,

König,

Meyer

et al. 2024

BMJ Open

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“…A rapid patient transfer to a hospital for surgery is also important, but is often delayed and requires good organization. 28…”

Section: Discussionmentioning

confidence: 99%

Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care – surgical delay because of initial misdiagnosis

Zaschke

Habazettl

Thurau

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background: Acute type A aortic dissection requires immediate surgical treatment, but the correct diagnosis is often delayed. This study aimed to analyse how initial misdiagnosis affected the time intervals before surgical treatment, symptoms associated with correct or incorrect initial diagnosis and the potential of the Aortic Dissection Detection Risk Score to improve the sensitivity of initial diagnosis. Methods: We conducted a retrospective analysis of 350 patients with acute type A aortic dissection. Patients were divided into two groups: initial misdiagnosis (group 0) and correct initial diagnosis of acute type A aortic dissection (group 1). Symptoms were analysed as predictors for the correct or incorrect initial diagnosis by multivariate analysis. Based on these findings, the Aortic Dissection Detection Risk Score was calculated retrospectively; a result ⩾2 was defined as a positive score. Results: The early suspicion of aortic dissection significantly shortened the median time from pain to surgical correction from 8.6 h in patients with an initial misdiagnosis to 5.5 h in patients with the correct initial diagnosis ( p<0.001). Of all acute type A aortic dissection patients, 49% had a positive Aortic Dissection Detection Risk Score. Of all initial misdiagnosed patients, 41% had a positive score (⩾2). The presence of lumbar pain ( p<0.001), any paresis ( p=0.037) and sweating ( p=0.042) was more likely to lead to the correct initial diagnosis. Conclusion: An early consideration of acute aortic dissection may reduce the delay of surgical care. The suggested Aortic Dissection Detection Risk Score may be a useful tool to improve the preclinical assessment.

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Incidence of acute type A aortic dissection in emergency departments

Wundram

Falk

Eulert-Grehn

et al. 2020

Sci Rep

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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

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Medikolegale Aspekte des präklinischen Managements von „akuten Aortensyndromen“

Cited by 4 publications

References 10 publications

Modelling years of life lost due to acute type A aortic dissection in the German healthcare setting: a predictive study

Modelling years of life lost due to acute type A aortic dissection in the German healthcare setting: a predictive study

Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care – surgical delay because of initial misdiagnosis

Incidence of acute type A aortic dissection in emergency departments

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