Key result
Thoracic CTA use for suspected acute aortic syndrome increased from approximately 150 to 350 per 100,000 patients between 2009 and 2019, while the mean annual AAS incidence remained stable.
Why the study?
Acute aortic syndrome is difficult to diagnose due to non-specific presentations, and the appropriate use of computed tomography aortography for suspected cases is uncertain.
Observational (n=1,646)
No
The use of thoracic CTA for suspected acute aortic syndrome has increased significantly over a 10-year period without a corresponding increase in the incidence of AAS diagnoses.
OBJECTIVE: Acute aortic syndrome (AAS) comprises a triad of life-threatening aortic conditions that are difficult to diagnose because of their non-specific clinical presentations. Contrast-enhanced computed tomography aortography (CTA) has a high sensitivity and specificity for these conditions. However, under- and over-investigation of patients with suspected AAS using CTA carries significant risk. The aim of the present study was to evaluate the diagnostic imaging practices of CTA use for patients presenting to an ED with suspected AAS. METHODS: All atraumatic thoracic CTAs performed on patients aged ≥15 years old with suspected AAS who presented to Auckland City Hospital between 2009 and 2019 were included. Outcomes of interest were the annual ED and population incidences of AAS, and the rate of CTAs performed. RESULTS: A total of 1646 CTAs were included. There were 135 (8.2%) cases of at least one AAS diagnosis and 220 (13.4%) cases where an alternative diagnosis was made. The population-adjusted number of AAS diagnoses remained relatively stable over the study period, with a mean annual AAS incidence of 19.6 (95% confidence interval 9.9-33.7) per 100 000 patients, and 3.2 (95% confidence interval 1.6-5.4) per 100 000 population. The number of ED presentations increased during the study period, along with the population-adjusted rate of CTAs performed, from approximately 150 per 100 000 patients (2009) to 350 per 100 000 patients (2019). CONCLUSIONS: Thoracic CTA use for investigating suspected AAS in our ED has recently increased. However, the annual incidence of AAS did not increase over the same period, but was higher than reported in overseas institutions.
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Waqanivavalagi et al. (2022) conducted an observational in Suspected acute aortic syndrome (n=1,646). Computed tomography aortography (CTA) was evaluated on Annual ED and population incidences of AAS, and the rate of CTAs performed. Thoracic CTA use for suspected acute aortic syndrome increased from approximately 150 to 350 per 100,000 patients between 2009 and 2019, while the mean annual AAS incidence remained stable.
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