Key result
Initial misdiagnosis occurred in 60% of patients with ruptured abdominal aortic aneurysm, but delay in diagnosis or treatment did not affect the overall mortality rate of 54%.
Why the study?
Does initial misdiagnosis or delay in diagnosis affect mortality in patients with ruptured abdominal aortic aneurysm?
Observational (n=97)
No
Does initial misdiagnosis or delay in diagnosis affect mortality in patients with ruptured abdominal aortic aneurysm?
A high rate of initial misdiagnosis (60%) occurs in ruptured abdominal aortic aneurysm, though in this cohort, delay in diagnosis did not significantly affect mortality.
High misdiagnosis rate in ruptured AAA warrants vigilance; this cohort study leaves open whether reducing delays improves survival.
OBJECTIVE: To evaluate the incidence of misdiagnosis in ruptured abdominal aortic aneurysm and its effect on treatment and outcome. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 97 consecutive patients admitted with ruptured abdominal aortic aneurysm during the 5-year period, 1 January 1989--31 December 1993. MAIN OUTCOME MEASURES: Initial diagnosis, interval between onset of symptoms and admission, and mortality. RESULTS: 38 Patients (43%) presented with symptoms of their aneurysm exceeding nine hours prior to admission (range 10 hours to 14 days, median 2 days). Fifty patients (60%) were initially misdiagnosed by the referring practitioner. Ultrasonography was consistent with rupture in only 36/70 (51%). 52 Patients died (54%), (operative mortality 45 (46%)), and was not affected by delay in diagnosis or treatment. CONCLUSIONS: Although delay in diagnosis or treatment did not seem to affect mortality, improved awareness of non-specific presentations of (imminent) rupture will result in fewer misdiagnoses and earlier treatment. A group of patients will undoubtedly benefit from this as they can be operated on at a stage when expected mortality is lower.
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Akkersdijk et al. (2002) conducted an observational in ruptured abdominal aortic aneurysm (n=97). Delay in diagnosis or treatment was evaluated on Initial diagnosis, interval between onset of symptoms and admission, and mortality. Initial misdiagnosis occurred in 60% of patients with ruptured abdominal aortic aneurysm, but delay in diagnosis or treatment did not affect the overall mortality rate of 54%.
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