Key result
Emergency clinicians miss acute aortic syndrome in ~72% of cases by omitting it from differentials.
Why the study?
The diagnosis of acute aortic syndrome (AAS) is often missed in emergency departments, and the reasons for these missed diagnoses are not well understood.
Cohort (n=43)
Yes
Objectives: To understand why the diagnosis of AAS is missed in the ED, and to characterise the presenting features of cases in which a diagnosis of AAS was missed. Methods: A retrospective case series cohort study was performed, identifying and analysing cases where AAS was misdiagnosed in three UK EDs between 1st January 2011 and 31st December 2020. Results: 43 cases were included, 22 of which were type A aortic dissections. The most common incorrect presumed diagnoses made were acute coronary syndrome (28%), pulmonary embolism (12%) and ‘non-specific chest pain’ (12%). In 31 cases (72%) there was no evidence from the notes that the clinician had considered AAS in the differential diagnosis. In 10 cases (23%), AAS was considered, but the clinician was falsely reassured by atypical or resolved symptoms, clinical examination, or normal chest x-ray. Conclusions: ED clinicians may miss AAS by not considering it as a possibility, being falsely reassured by atypical or resolved symptoms, or mistaking it for other more common conditions. Further prospective work is necessary to establish the role of diagnostic aids and biomarkers in UK EDs.
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McLatchie et al. (2023) conducted a cohort in Acute Aortic Syndrome (n=43). Emergency Department evaluation was evaluated on Reason for missed diagnosis of Acute Aortic Syndrome. Emergency department clinicians missed the diagnosis of acute aortic syndrome primarily by not considering it in the differential diagnosis (72% of cases), often misdiagnosing it as acute coronary syndrome (28%) or pulmonary embolism (12%).
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