Point-of-Care Ultrasound Use in Confirmed Acute Aortic Syndrome: A Five-Year Retrospective Cohort Study at the Ljubljana Emergency Medical Unit

Background/Objectives: Point-of-care ultrasound (POCUS) is increasingly used in emergency care, but data on its use in acute aortic syndrome (AAS) remains limited. This single-center retrospective cohort described POCUS use among patients with confirmed AAS and explored factors associated with POCUS use and time to completion of diagnostic workup. Methods: Records coded ICD10 I71.0–I71.8 from the Emergency Medical Unit, University Medical Centre Ljubljana (2019–2023) were reviewed. Clinical, imaging, and outcome data were extracted, and diagnoses were confirmed by two investigators through manual chart review of ED documentation, radiology reports, and specialist consultation notes. Fisher’s exact and Wilcoxon rank sum tests were used for comparisons. Associations with POCUS use and time to completion of diagnostic workup (defined from arrival at triage to completion of the emergency department workup) were assessed with univariable logistic regression and linear regression models, respectively. Survival was explored using univariable Cox proportional-hazards models. Statistical significance was set at p < 0.05. Results: Among 120,109 emergency department visits, 73 patients had confirmed AAS (type A: 48; type B: 17; intramural hematoma: 8). POCUS was performed in 62% of patients, more often in those who were hemodynamically unstable (87.5% vs. 54.4%; p = 0.020) or had unclear presentations (40% vs. 7%; p = 0.003). Median time to completion of diagnostic workup was shorter with POCUS (110 vs. 213 min), though not statistically significant (p = 0.069). Hemodynamic instability was associated with higher odds of POCUS use (OR 5.87, 95% CI 1.22–28.2; p = 0.028), whereas a clear clinical presentation was associated with lower odds of POCUS use (OR 0.12, 95% CI 0.02–0.55; p = 0.007). Lower triage level was associated with longer time to completion of diagnostic workup (time ratio 5.43, 95% CI 2.21–13.4; p < 0.001 for urgent vs. immediate triage), whereas very high D-dimer levels were associated with shorter time to completion of diagnostic workup (time ratio 0.44, 95% CI 0.21–0.93; p = 0.031 for highest vs. lowest quartile). In-hospital mortality was 14%, with only age associated with mortality (HR 1.06 per year, 95% CI 1.02–1.11; p = 0.007). Conclusions: In this single-center retrospective AAS cohort, POCUS was used more frequently in unstable and diagnostically unclear patients but was not associated with time to completion of diagnostic workup. Findings are descriptive and exploratory; they do not establish that POCUS accelerates diagnosis or improves outcomes.