Misdiagnosis of aortic dissection: A systematic review of the literature

Lovatt, Saul; Wong, Chun Wai; Schwarz, Konstantin; Borovac, Josip Anđelo; Lo, Ted; Gunning, Mark; Phan, Thanh Trung; Patwala, Ashish; Barker, Diane; Mallen, Christian; Kwok, Chun Shing

doi:10.1016/j.ajem.2021.11.047

Cited by 51 publications

(40 citation statements)

References 29 publications

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“…The clinical database was queried to include all patients admitted to our institution with a diagnosis of ATAAD and undergoing emergency operation between October 2016 and April 2019. The exclusion criteria were as follows: (1) the time from onset to admission longer than 7 days; (2) the time from admission to surgery longer than 24 hours; (3) emergency operation for giant true aneurysm or type B aortic dissection; (4) patients who were too sick for surgery or refused surgery; (5) patients died before emergency operation. According to whether preoperative coronary angiography was performed, the patients were divided into CA group and NCA group.…”

Section: Methodsmentioning

confidence: 99%

“…The clinical presentation of ATAAD and acute coronary syndrome (ACS) can be remarkably similar, making differential diagnosis very di cult [4,5]. Patients with ATAAD were occasionally misdiagnosed as ACS and transferred to a catheterization laboratory to undergo coronary angiography (CA) without knowledge of the ATAAD (unintentional CA) [6][7][8].…”

Section: Survival Relies On the Rapid Accurate Diagnosis And Timely L...mentioning

confidence: 99%

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Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

Peng

Liu²,

Jian³

et al. 2022

Preprint

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Background: This study investigated the impact of coronary angiography on outcomes of emergency operation in acute type A aortic dissection (ATAAD) patients who were initially misdiagnosed as the acute coronary syndrome.Methods: From October 2016 to April 2019, 129 patients underwent surgery for ATAAD in our institution, including 21 patients (16.3%, CA group) who received preoperative coronary angiography without knowledge of the ATAAD, and the rest 108 did not (NCA group). Preoperative clinical characteristics, surgical mortality and postoperative complications were compared. Multivariable logistic regression was performed to confirm the independent prognostic factors for short-term and long-term outcomes.Results: Patients undergoing coronary angiography had higher prevalence of preoperative hypotension or shock (61.9% vs 35.2%, P=0.022), ischemic changes on electrocardiogram (66.7% vs 37.0%, P=0.012), platelet inhibition (ADP-induced inhibition 92.0% vs 46.0%, P=0.001), and coronary involvement (66.7% vs 30.6%, P=0.002). 30-day/in-hospital mortality was 4.8% versus 9.3% (P=0.84). CA group had more intraoperative bleeding (1900ml vs 1500ml, P=0.013) and chest-tube drainage on the first postoperative day (1040ml vs 595ml, P=0.028). However, preoperative coronary angiography was not independent risk factors for surgical mortality (OR 0.171, 95%CI 0.013-2.174, P=0.173) and overall survival (HR 0.407; 95%CI 0.080-2.057; P=0.277). Conclusion: Patients undergoing coronary angiography carried a higher risk of preoperative hemodynamic instability, myocardial ischemia, and perioperative bleeding. However, unintentional coronary angiography did not have a significant impact on short-term and long-term outcomes of emergency surgery in ATAAD.

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Section: Methodsmentioning

confidence: 99%

Section: Survival Relies On the Rapid Accurate Diagnosis And Timely L...mentioning

confidence: 99%

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

Peng

Liu²,

Jian³

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…14 Fourth, it is presumed that clinicians reviewing a patient would make the correct diagnosis and order the right tests but the reality is that misdiagnosis is part of everyday practice that has been observed in acute myocardial infarction, 15 heart failure, 16 and aortic dissection. 17 Finally, it is expected that the right treatment is started, and it is very different the treatment started by an expert versus nonexpert in the area as well as an inexperienced trainee compared with an experienced specialist.…”

Section: Events That Happen To Patients and Assumptionsmentioning

confidence: 99%

Patient Pathways in Cardiology: Should Pharmaceutical and Medical Device Companies Care?

Kwok

Muntean

Foster

et al. 2022

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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A shared goal of patients, providers, and the companies that produce new therapies is to have these therapies used according to guidelines. Health services specialize in patient care and may lack the capabilities to take a product from conception through to everyday use. This results in a mutually beneficial relationship between health services and industry. The market for cardiovascular drugs is significant, which results in competition between companies. While traditional methods of observational analysis may be able to determine to what extent drugs and devices are being prescribed or implanted by health providers, there is less real-world patient level insight as to why patients are taking (or not taking) these treatments and why one agent is chosen over another. Considering patient pathways is a novel approach that can be utilized to understand real-world patient activities. This approach focuses on the patient flow across the healthcare system and barriers at each stage including identification of patients, diagnostic testing, the decisions on treatment, and prescribing can help identify ways of improving the utilization based on guidelines. It overcomes several assumptions related to patient and clinician decision-making and practical considerations such as geography and availability of health services. In this article, we introduce the concept of patient pathways and why considering them maybe of interest to companies. As significant resources are invested to bring a product to market, this approach can help define if there are missed opportunities for their products to be utilized and potential barriers to implementation.

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“…For example, misdiagnosis has been identified to be frequent in conditions such as acute myocardial infarction [ 6 ], heart failure [ 7 ], aortic dissection [ 8 ], and pulmonary embolism [ 9 ]. Moreover, there may be limited resources or services in the area where the patient lives as there may be discrepancy in ease of access to healthcare depending on whether the area is urban or rural.…”

Section: Patient Pathwaysmentioning

confidence: 99%

Should Audits Consider the Care Pathway Model? A New Approach to Benchmarking Real-World Activities

et al. 2022

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Clinical audit is a method to assess the quality of healthcare services based on whether standards are met or not met. This approach is limited because it fails to recognize how decisions that take place over time and the natural progression of disease has an impact on what happens to patients and the care they receive. The aim of this paper is to introduce the concept of care pathway and explain how care pathways can be audited to better understand care. The care pathway is defined by clinically relevant events that take place within one or more healthcare institutions. The process begins with defining an ideal care pathway which is created by considering local expertise and guidelines. It is then possible to audit against the extent to which this ideal care pathway is achieved. This care pathway audit can enable identification of patterns in real-world care which can help with the of design interventions to help shift patients from the less to more desirable pathways. We conclude that through the process of the care pathway audit cycle, it is possible to learn about real-world activities, better utilize resources, promote safer care, improve quality of care, and help develop more effective interventions.

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Misdiagnosis of aortic dissection: A systematic review of the literature

Cited by 51 publications

References 29 publications

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

Patient Pathways in Cardiology: Should Pharmaceutical and Medical Device Companies Care?

Should Audits Consider the Care Pathway Model? A New Approach to Benchmarking Real-World Activities

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