Key result
Absence of point-of-care ultrasound exam was strongly associated with misdiagnosis of type A acute aortic dissection in the emergency department (OR 13.00; 95% CI 3.05-55.40; P=0.001).
Why the study?
TAAAD has high mortality requiring prompt diagnosis, but misdiagnosis is common in the ED. The study evaluated the misdiagnosis rate, associated factors, and patient outcomes.
What are the factors associated with misdiagnosis of type A acute aortic dissection in the emergency department, and does misdiagnosis affect patient outcomes?
Cohort (n=91)
No
What are the factors associated with misdiagnosis of type A acute aortic dissection in the emergency department, and does misdiagnosis affect patient outcomes?
Odds Ratio: 13 (95% CI 3.05–55.4)
p-value: p=0.001
One-third of type A acute aortic dissection cases in the ED are misdiagnosed, with absence of severe pain, lower triage urgency, and lack of POCUS being key associated factors, though misdiagnosis did not significantly alter mortality in this cohort.
POCUS omission linked to type A dissection misdiagnosis; leaves open whether routine use improves accuracy in prospective ED studies.
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.
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Cheung et al. (2024) conducted a cohort in Type A acute aortic dissection (TAAAD) (n=91). Absence of point-of-care ultrasound exam (POCUS) vs. Presence of POCUS was evaluated on Misdiagnosis of TAAAD (OR 13.00, 95% CI 3.05-55.40, p=0.001). Absence of point-of-care ultrasound exam was strongly associated with misdiagnosis of type A acute aortic dissection in the emergency department (OR 13.00; 95% CI 3.05-55.40; P=0.001).
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