Abstract
Objective
This study aims to explore the risk factors and predictors involved in the missed
diagnosis of acute aortic dissection (AAD) among patients in the emergency medicine
department (EMD).
Methods
This is a single-center retrospective chart review conducted over a 10-year period
(January 1998 to December 2008). Records with a diagnosis of “dissection of aorta”
(International Classification of Diseases, Ninth Revision code 441.0) from the hospital discharge database and hospital death register were
selected. Acute aortic dissection was defined as missed if diagnostic imaging to diagnose AAD or cardiothoracic surgeon
consult was not elicited while in the EMD. We compared the history, clinical findings,
and investigations between patients who had the diagnosis of AAD missed in the EMD
and those who did not.
Results
A total of 68 patients were included in the analysis during the study period, of which
38.2% had a missed diagnosis. There was 63.2% of type A AAD by Stanford classification.
Neither age, sex, nor a history of hypertension were significant risk factors for
missed diagnosis of AAD. The likelihood of missed diagnosis was significantly higher
in the absence of a pulse deficit (odds ratio, 35.76; 95% confidence interval, 3.70-345.34)
and absence of widened mediastinum on chest radiography (odds ratio, 33.16; 95% confidence
interval, 5.74-191.49).
Conclusion
Well-known risk factors for AAD such as age, male sex, and hypertension were not risk
factors for missed diagnosis for AAD presenting in the EMD. The absence of pulse deficit
or widened mediastinum does not exclude the diagnosis of AAD.
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Article Info
Publication History
Published online: February 10, 2012
Accepted:
November 23,
2011
Received in revised form:
November 16,
2011
Received:
April 2,
2011
Footnotes
?Conflict of interest statement: The authors declare no conflict of interest.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
