https://doi.org/10.4081/ecj.2023.11153
Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis
Submitted: 13 January 2023
Accepted: 6 March 2023
Published: 28 March 2023
Accepted: 6 March 2023
Abstract Views: 1115
PDF: 487
Supplementary Materials: 74
Supplementary Materials: 74
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
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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How to Cite
McLatchie, R., Wilson, S., Reed, M., Ticehurst, F., Easterford, K., Alawiye, S., Cowan, A., & Gupta, A. (2023). Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis. Emergency Care Journal, 19(1). https://doi.org/10.4081/ecj.2023.11153
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