Diagnosis of Aortic Dissection in Emergency Department Patients is Rare

Abstract

IntroductionAortic dissection is a rare event. While the most frequent symptom is chest pain, that is a common emergency department (ED) chief complaint and other diseases causing chest pain occur much more often. Furthermore, 20% of dissections are without chest pain and 6% are painless. For these reasons, diagnosing dissections may be challenging. Our goal was to determine the number of total ED and atraumatic chest pain patients for every aortic dissection diagnosed by emergency physicians.MethodsDesign: Retrospective cohort. Setting: 33 suburban and urban New York and New Jersey EDs with annual visits between 8,000 and 80,000. Participants: Consecutive patients seen by emergency physicians from 1-1-1996 through 12-31-2010. Observations: We identified aortic dissection and atraumatic chest pain patients using the International Classification of Diseases 9th Revision and Clinical Modification codes. We then calculated the number of total ED and atraumatic chest pain patients for every aortic dissection, along with 95% confidence intervals (CIs).ResultsFrom a database of 9.5 million ED visits, we identified 782 aortic dissections or one for every 12,200 (95% CI [11,400–13,100]) visits. The mean age of dissection patients was 66±16 years and 38% were female. There were 763,000 (8%) with atraumatic chest pain diagnoses. Thus, there is one dissection for every 980 (95% CI [910–1,050]) atraumatic chest pain patients.ConclusionThe diagnosis of aortic dissections by emergency physicians is rare and challenging. An emergency physician seeing 3,000 to 4,000 patients a year would diagnose an aortic dissection approximately every three to four years.

Assessing adequacy of emergency provider documentation among interhospital transferred patients with acute aortic dissection

“…Adult patients for potential inclusion were identifi ed within our electronic medical record system using the International Classification of Diseases, 9th version (ICD-9) and coding for aortic diseases at 441.XX. [14] Patients who were transferred directly from another emergency department (ED) to our academic medical center for management of acute aortic dissections were included. Patients who initially presented to our academic medical center and those who were not a direct transfer from a referring ED were excluded.…”

“…. Mean patient age was 61(14) years; median length of stay in the ED was 300 [205-415] minutes; mean triage SBP and HR were 150 (42) mmHg and 78(19) beats/minute, respectively; mean SBP and HR at referring ED departure were 139 (31) mmHg and 77(16) beats/minute, respectively.Among 287 ED clinical records analyzed, 105 (36.6%) contained adequate documentation of clinical care. However, 182 (63.4%) ED clinical records were…”

Taming the zebra: Unravelling the barriers to diagnosing aortic dissection

“…The reported incidence of AD varies in the available literature but is thought to be 3.5 per 100 000 cases . One study reported an ED incidence of 1 in 12, 200 patients per year from a database of 9.5 million ED patients …”

“…2 One study reported an ED incidence of 1 in 12, 200 patients per year from a database of 9.5 million ED patients. 3 Timely diagnosis is crucial. Without treatment, Type A dissection is reported to have a cumulative mortality of 1-2% per hour, rising to an 80% mortality within 2 weeks.…”

Clinical recognition of acute aortic dissections: insights from a large single-centre cohort study

“…However, its diagnosis is challenging given heterogeneous symptoms and a low incidence estimated at 2.6–6 cases per 100,000 person-years [ 1 – 3 ]. Although 8–10% of all patients admitted to a general emergency care department present with acute chest pain, only one in 980 of these patients will have an acute aortic dissection [ 4 , 5 ].…”