Incidence of acute type A aortic dissection in emergency departments
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Key result
Autopsy data suggests ~50% of acute type A aortic dissections remain undetected in the ED.
- 95% CI 5.17-5.29
- n=12,790,577
Why the study?
How often acute type A aortic dissection occurs in an emergency department per year was studied, as emergency department incidence may serve as a quality marker for differential diagnostics of acute chest pain.
Population
12,790,577 emergency department patients across Berlin hospitals
Design
Multi-institutional retrospective study
Authors
Discussion
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Implication
Up to half of acute type A aortic dissections may go undetected; leaves open whether targeted imaging or autopsy protocols can improve case ascertainment.
Study Design
Type
Observational (n=12,790,577)
Multicenter
Yes
Structured PICO
P
Population
12,790,577 emergency department patients in Berlin, Germany, between 2006 and 2016, among whom 631 clinical cases of acute type A aortic dissection (ATAAD) were identified.
O
Outcome
Incidence of acute type A aortic dissection in the emergency departmenthard clinical
The incidence of acute type A aortic dissection in emergency departments is approximately 5.24 per 100,000 patients, though autopsy data suggests up to 50% of cases may remain undetected.
Limitations
- Study periods varied between Charité (2010-2016), Vivantes, and Berlin (2006-2016).
- The ED population for 2016 was missing and had to be estimated based on the evolution of patient numbers.
- Autopsy data was provided only from the Vivantes clinics.
- The overall autopsy rate was 5.95%, which is not enough to provide reliable numbers on undetected cases.
- Missing ED population data for 2016 had to be estimated based on annual increase
- Autopsy data was provided only from Vivantes clinics with a low overall autopsy rate (5.95%)
- Extrapolation of undetected numbers to all Berlin hospitals should be considered with care
Cite This Study
Wundram et al. (2020) conducted an observational in Acute type A aortic dissection (n=12,790,577). The emergency department incidence of acute type A aortic dissection in Berlin was 5.24 cases per 100,000 patients, with autopsy data suggesting up to 50% of cases may remain undetected.
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