Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study
The aim of this study was to describe the presentation of patients with ruptured abdominal aortic aneurysm (rAAA) and identify factors contributing toward misdiagnosis.This was an observational study of cases with a final diagnosis of rAAA assessed at nine Emergency Departments and managed at one of...
| Main Authors: | , , , , , |
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| Format: | Journal article |
| Language: | English |
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Lippincott, Williams & Wilkins
2016
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| _version_ | 1826294330472529920 |
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| author | Metcalfe, D Sugand, K Thrumurthy, S Thompson, M Holt, P Karthikesalingam, A |
| author_facet | Metcalfe, D Sugand, K Thrumurthy, S Thompson, M Holt, P Karthikesalingam, A |
| author_sort | Metcalfe, D |
| collection | OXFORD |
| description | The aim of this study was to describe the presentation of patients with ruptured abdominal aortic aneurysm (rAAA) and identify factors contributing toward misdiagnosis.This was an observational study of cases with a final diagnosis of rAAA assessed at nine Emergency Departments and managed at one of two regional vascular centres in the UK.Eighty-five consecutive cases were included. Seventeen [20.0%, 95% confidence interval (CI) 11.5-28.5%] patients reported important symptoms up to 3 weeks before index presentation. In the Emergency Department, most patients complained of abdominal and/or back pain, seven (8.2%, 95% CI 2.4-14.0%) additionally reported atypical pain and ten (11.8%, 95% CI 4.9-18.7%) denied pain altogether. Hypotension (36.5%, 95% CI 26.3-46.7%), tachycardia (18.8%, 95% CI 10.5-27.1%) and syncope (36.5%, 95% CI 26.3-46.7%) were documented in a minority of cases. Distracting symptoms were present in 33 (38.8%, 95% CI 28.4-49.2%) patients. The median time to diagnosis was 17.5 min (range immediate-12 days), and 21 (25.6%, 95% CI 16.3-34.9%) patients were misdiagnosed during clinical assessment.The classical signs and symptoms or rAAA are not always present and patients frequently show additional features that may confound the diagnosis. A high level of suspicion should be adopted for rAAA alongside a low threshold for immediate computed tomography. Further research is required to develop an objective clinical risk score or predictive tool for characterizing patients at risk. |
| first_indexed | 2024-03-07T03:43:58Z |
| format | Journal article |
| id | oxford-uuid:bed2bf98-f879-4e3d-9d22-f75246404b78 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:43:58Z |
| publishDate | 2016 |
| publisher | Lippincott, Williams & Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:bed2bf98-f879-4e3d-9d22-f75246404b782022-03-27T05:42:49ZDiagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:bed2bf98-f879-4e3d-9d22-f75246404b78EnglishSymplectic Elements at OxfordLippincott, Williams & Wilkins2016Metcalfe, DSugand, KThrumurthy, SThompson, MHolt, PKarthikesalingam, AThe aim of this study was to describe the presentation of patients with ruptured abdominal aortic aneurysm (rAAA) and identify factors contributing toward misdiagnosis.This was an observational study of cases with a final diagnosis of rAAA assessed at nine Emergency Departments and managed at one of two regional vascular centres in the UK.Eighty-five consecutive cases were included. Seventeen [20.0%, 95% confidence interval (CI) 11.5-28.5%] patients reported important symptoms up to 3 weeks before index presentation. In the Emergency Department, most patients complained of abdominal and/or back pain, seven (8.2%, 95% CI 2.4-14.0%) additionally reported atypical pain and ten (11.8%, 95% CI 4.9-18.7%) denied pain altogether. Hypotension (36.5%, 95% CI 26.3-46.7%), tachycardia (18.8%, 95% CI 10.5-27.1%) and syncope (36.5%, 95% CI 26.3-46.7%) were documented in a minority of cases. Distracting symptoms were present in 33 (38.8%, 95% CI 28.4-49.2%) patients. The median time to diagnosis was 17.5 min (range immediate-12 days), and 21 (25.6%, 95% CI 16.3-34.9%) patients were misdiagnosed during clinical assessment.The classical signs and symptoms or rAAA are not always present and patients frequently show additional features that may confound the diagnosis. A high level of suspicion should be adopted for rAAA alongside a low threshold for immediate computed tomography. Further research is required to develop an objective clinical risk score or predictive tool for characterizing patients at risk. |
| spellingShingle | Metcalfe, D Sugand, K Thrumurthy, S Thompson, M Holt, P Karthikesalingam, A Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study |
| title | Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study |
| title_full | Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study |
| title_fullStr | Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study |
| title_full_unstemmed | Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study |
| title_short | Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study |
| title_sort | diagnosis of ruptured abdominal aortic aneurysm a multicentre cohort study |
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