Key result
Patients presenting with atypical symptoms of acute aortic dissection experienced a significantly longer median diagnostic delay compared to those with typical symptoms (186 vs 31 minutes, p=0.006).
Why the study?
Acute aortic dissection is fatal if untreated and presents with symptoms often similar to common conditions, requiring strategies to identify atypical symptoms in a timely manner.
Does a triage strategy incorporating atypical symptoms and D-dimer testing reduce diagnostic delay for acute aortic dissection in the emergency department?
Observational (n=59)
No
Does a triage strategy incorporating atypical symptoms and D-dimer testing reduce diagnostic delay for acute aortic dissection in the emergency department?
Absolute Event Rate: 186% vs 31%
p-value: p=0.006
Incorporating atypical symptoms and D-dimer testing into emergency department triage protocols may help reduce diagnostic delays for acute aortic dissection.
Prolonged diagnostic delay with atypical acute aortic dissection symptoms; hypothesis-generating for D-dimer-inclusive triage pending prospective validation.
Background/aim: Acute aortic dissection (AAD) is a rare but fatal disease if left untreated. Symptoms are often similar to common conditions; therefore, the diagnostic strategy is important. We aimed to identify the atypical symptoms in a timely manner without putting patients at greater risk for undetected AAD. Materials and methods: We conducted a retrospective observational study of 59 AAD patients with both atypical and typical symptoms from January 2012 to December 2016. Patients with atypical symptoms continuing more than 30 min underwent a D-dimer test and computed tomography (CT) or computed tomographic angiography (CTA). Results: Of the 59 AAD patients, 22 were atypical. In the atypical group, the median delay time in our hospital was 3.1 h; average delay time after July 2015 was shorter than average delay time before June 2015 (16.59 ± 24.70 vs. 1.90 ± 0.57 h, P = 0.076). Conclusions: For patients in the emergency department who are suspected of having AAD, incorporating atypical symptoms with high levels of D-dimer into a triage strategy could improve the efficiency of clinical decision making. Furthermore, essential education directed towards the recognition of the atypical symptoms of AAD for front-line physicians may aid in a timely diagnosis, as compared with the usual assessments in the emergency department.
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Jiang et al. (2019) conducted an observational in Acute aortic dissection (n=59). Atypical symptoms vs. Typical symptoms was evaluated on Median time from admission to definite diagnosis (delay time) in minutes (p=0.006). Patients presenting with atypical symptoms of acute aortic dissection experienced a significantly longer median diagnostic delay compared to those with typical symptoms (186 vs 31 minutes, p=0.006).
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