Misdiagnosis of type A acute aortic dissection in the emergency department: 10 Year retrospective cohort study
Abstract Background Type A acute aortic dissection (TAAAD) is a serious cardiovascular disease with a high mortality rate and prompt diagnosis is the key to survival. However, misdiagnosis is common in the Emergency Department (ED). The aim of this study is to evaluate the rate of misdiagnosis, fact...
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Wiley
2024-12-01
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| Series: | Hong Kong Journal of Emergency Medicine |
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| Online Access: | https://doi.org/10.1002/hkj2.12066 |
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| author | Qi Tian Ralph Koon Ho Cheung Chi Hung Cheng Kevin Kei Ching Hung Colin Alexander Graham |
| author_facet | Qi Tian Ralph Koon Ho Cheung Chi Hung Cheng Kevin Kei Ching Hung Colin Alexander Graham |
| author_sort | Qi Tian |
| collection | DOAJ |
| description | Abstract Background Type A acute aortic dissection (TAAAD) is a serious cardiovascular disease with a high mortality rate and prompt diagnosis is the key to survival. However, misdiagnosis is common in the Emergency Department (ED). The aim of this study is to evaluate the rate of misdiagnosis, factors associated with misdiagnosis and patient outcomes. Methods This retrospective cohort study recruited 91 patients with TAAAD at the ED of a tertiary university hospital in Hong Kong from 2013 to 2022. Patients were divided into the following two groups: correct diagnosis (60 patients) and misdiagnosis (31 patients) of TAAAD. Clinical symptoms, signs, and investigations were analyzed as factors associated with misdiagnosis by multivariate analysis. In‐patient mortality, 30‐day mortality, 1‐year mortality, and hospital length of stay (LOS) were compared between the two groups. Results The misdiagnosis rate of TAAAD was 34.1% (31/91). Absence of severe intensity pain (OR = 6.01, 95% confidence interval [CI] = 1.41–25.63, p = 0.015), less urgent triage category (OR = 4.46, 95% CI = 1.77–11.22, p = 0.002), and absence of point‐of‐care ultrasound exam (POCUS) (OR = 13.00, 95% CI = 3.05–55.40, p = 0.001) were associated with misdiagnosis. There were no statistically significant differences between correct diagnosis and misdiagnosis groups in patient outcomes including in‐hospital mortality (28.3% vs. 38.7%), 30‐day mortality (28.3% vs. 38.7%), 1‐year mortality (30.0% vs. 41.9%), or hospital LOS (15.5 ± 15.6 days vs. 14.7 ± 15.5 days). Conclusions One‐third of cases in our study were misdiagnosed. The absence of severe intensity pain, less urgent triage category, and absence of POCUS ultrasound exam were independent factors associated with misdiagnosis. More widespread use of POCUS of the aorta and heart may help to improve the diagnosis of TAAAD in the ED. |
| format | Article |
| id | doaj-art-ba514b128bb445d6a84f290acdc5c5f4 |
| institution | DOAJ |
| issn | 1024-9079 2309-5407 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Hong Kong Journal of Emergency Medicine |
| spelling | doaj-art-ba514b128bb445d6a84f290acdc5c5f42025-08-20T02:52:45ZengWileyHong Kong Journal of Emergency Medicine1024-90792309-54072024-12-0131638339110.1002/hkj2.12066Misdiagnosis of type A acute aortic dissection in the emergency department: 10 Year retrospective cohort studyQi Tian0Ralph Koon Ho Cheung1Chi Hung Cheng2Kevin Kei Ching Hung3Colin Alexander Graham4Trauma & Emergency Centre Prince of Wales Hospital New Territories Hong KongTrauma & Emergency Centre Prince of Wales Hospital New Territories Hong KongTrauma & Emergency Centre Prince of Wales Hospital New Territories Hong KongTrauma & Emergency Centre Prince of Wales Hospital New Territories Hong KongTrauma & Emergency Centre Prince of Wales Hospital New Territories Hong KongAbstract Background Type A acute aortic dissection (TAAAD) is a serious cardiovascular disease with a high mortality rate and prompt diagnosis is the key to survival. However, misdiagnosis is common in the Emergency Department (ED). The aim of this study is to evaluate the rate of misdiagnosis, factors associated with misdiagnosis and patient outcomes. Methods This retrospective cohort study recruited 91 patients with TAAAD at the ED of a tertiary university hospital in Hong Kong from 2013 to 2022. Patients were divided into the following two groups: correct diagnosis (60 patients) and misdiagnosis (31 patients) of TAAAD. Clinical symptoms, signs, and investigations were analyzed as factors associated with misdiagnosis by multivariate analysis. In‐patient mortality, 30‐day mortality, 1‐year mortality, and hospital length of stay (LOS) were compared between the two groups. Results The misdiagnosis rate of TAAAD was 34.1% (31/91). Absence of severe intensity pain (OR = 6.01, 95% confidence interval [CI] = 1.41–25.63, p = 0.015), less urgent triage category (OR = 4.46, 95% CI = 1.77–11.22, p = 0.002), and absence of point‐of‐care ultrasound exam (POCUS) (OR = 13.00, 95% CI = 3.05–55.40, p = 0.001) were associated with misdiagnosis. There were no statistically significant differences between correct diagnosis and misdiagnosis groups in patient outcomes including in‐hospital mortality (28.3% vs. 38.7%), 30‐day mortality (28.3% vs. 38.7%), 1‐year mortality (30.0% vs. 41.9%), or hospital LOS (15.5 ± 15.6 days vs. 14.7 ± 15.5 days). Conclusions One‐third of cases in our study were misdiagnosed. The absence of severe intensity pain, less urgent triage category, and absence of POCUS ultrasound exam were independent factors associated with misdiagnosis. More widespread use of POCUS of the aorta and heart may help to improve the diagnosis of TAAAD in the ED.https://doi.org/10.1002/hkj2.12066aortic dissectionemergencymortalitypoint‐of‐care ultrasoundultrasound |
| spellingShingle | Qi Tian Ralph Koon Ho Cheung Chi Hung Cheng Kevin Kei Ching Hung Colin Alexander Graham Misdiagnosis of type A acute aortic dissection in the emergency department: 10 Year retrospective cohort study Hong Kong Journal of Emergency Medicine aortic dissection emergency mortality point‐of‐care ultrasound ultrasound |
| title | Misdiagnosis of type A acute aortic dissection in the emergency department: 10 Year retrospective cohort study |
| title_full | Misdiagnosis of type A acute aortic dissection in the emergency department: 10 Year retrospective cohort study |
| title_fullStr | Misdiagnosis of type A acute aortic dissection in the emergency department: 10 Year retrospective cohort study |
| title_full_unstemmed | Misdiagnosis of type A acute aortic dissection in the emergency department: 10 Year retrospective cohort study |
| title_short | Misdiagnosis of type A acute aortic dissection in the emergency department: 10 Year retrospective cohort study |
| title_sort | misdiagnosis of type a acute aortic dissection in the emergency department 10 year retrospective cohort study |
| topic | aortic dissection emergency mortality point‐of‐care ultrasound ultrasound |
| url | https://doi.org/10.1002/hkj2.12066 |
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