Key result
Patients diagnosed with ruptured or symptomatic AAA in the emergency department had surgical repair 40.8 hours earlier than those with delayed diagnosis (p=0.006).
Why the study?
Does early diagnosis in the emergency department using ultrasound improve time to surgical repair in patients with ruptured abdominal aortic aneurysm?
Observational (n=26)
No
Does early diagnosis in the emergency department using ultrasound improve time to surgical repair in patients with ruptured abdominal aortic aneurysm?
A high index of suspicion and the use of emergency ultrasound in the emergency department significantly reduces the time to surgical repair for patients with ruptured abdominal aortic aneurysms.
ED diagnosis of ruptured AAA was associated with earlier repair; supports targeted ultrasound but requires prospective trials to confirm outcomes.
Objectives To review the clinical presentations and outcomes of patients with ruptured abdominal aortic aneurysm (AAA) in a regional hospital and its evaluation in the accident and emergency department (AED). Methods This is a retrospective observational study of patients admitted through the AED with the discharge or post‐mortem diagnosis of ruptured AAA from 1st January 2002 to 31st December 2008 in a regional pubic hospital of Hong Kong. Their demographic and clinical data were recorded and analysed. The sensitivity of the AED in detecting ruptured AAA or symptomatic AAA was evaluated. Results Twenty‐six patients were found to have ruptured AAA and included in the study. All were Chinese. Seventeen patients had repair surgery done by open surgical method. Eighteen (69%) patients were diagnosed to have ruptured AAA or found to have symptomatic AAA in the AED. Three (12%) ruptured AAAs were diagnosed at post‐mortem. The most common presenting symptoms were abdominal pain (73%) and loss of consciousness (46%). Only five (19%) patients had the classical triad of abdominal pain, haemorrhagic shock and a pulsatile abdominal mass. Ultrasound of aorta was performed in 74% of cases in the group with ruptured AAA or symptomatic AAA diagnosed in the AED but none in the delayed diagnosis group (p=0.001). The former group were 3.7 times more likely to proceed to repair surgery (p=0.188) and had surgical repair operation 40.8 hours earlier than the latter group (p=0.006). Systolic blood pressure less than 90 mmHg at any time point before operation was found to correlate significantly with mortality (p=0.029). Conclusion A high index of suspicion and prompt recognition of ruptured AAA is of paramount importance. Emergency physicians should familiarise themselves with the clinical presentation and management of patients with ruptured AAA. Emergency ultrasound performed in the AED helps in the early detection of AAA.
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NH Chu (2010) conducted an observational in ruptured abdominal aortic aneurysm (AAA) (n=26). Diagnosis of ruptured or symptomatic AAA in the emergency department vs. Delayed diagnosis was evaluated on Proceeding to repair surgery (3.7 times more likely, p=0.188). Patients diagnosed with ruptured or symptomatic AAA in the emergency department had surgical repair 40.8 hours earlier than those with delayed diagnosis (p=0.006).
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