A simple intervention to reduce your chance of missing an acute aortic dissection

Chest Pain-Specific Legal Risk

Chest pain is a common chief complaint in the emergency department. When looking at patients with chest pain cases of acute coronary syndrome, pulmonary embolism and aortic dissection account for the majority of cases that involve an allegation of malpractice. While it is likely impossible to catch all these cases having a structured approach to these patients may improve outcomes for both patients and clinicians.

Balancing the Legal Risk to the Clinician with the Medical Interests of the Patient

The balance between risk of missing serious disease and potential harms from over testing involves knowledge of the literature, familiarity of clinical guidelines, incorporation of clinical decision tools where appropriate, use of metacognition to be aware of cognitive decisions to respond and use of shared decision-making in the context of a patient's presentation and with the guidance of the clinician.

Early Diagnosis of an Atypical Type A Aortic Dissection With Point-of-Care Ultrasound: A Case Report

Aortic dissection is a rare but potentially fatal condition, characterized by a high mortality rate where every minute of delay in treatment counts. Its diagnosis remains challenging due to its often atypical clinical presentation. This case report presents an atypical case of type A aortic dissection in a 75-year-old female patient, highlighting the importance of early diagnosis facilitated by point-of-care ultrasound and emphasizing the value of its use in suspected aortic dissection regardless of the clinical probability. Additionally, this report reviews the risk factors for misdiagnosis and underscores the utility of diagnostic scores such as the aortic dissection detection risk score.

Risk assessment and disease burden of extreme precipitation on hospitalizations for acute aortic dissection in a subtropical coastal Chinese city

Background

Extreme precipitation events are becoming more frequent due to climate change. The present study aimed to explore the impacts of extreme precipitation on hospitalizations for acute aortic dissection (AAD) and to identify susceptible populations and quantify the corresponding disease burden.

Methods

The present study used a distributed lag nonlinear model (DLNM) with a quasi-Poisson function to investigate the association between extreme precipitation (≥95th percentile) and the risk of hospitalizations for AAD from 2015 to 2020 in Shantou, Guangdong Province, China.

Results

The significant adverse effects of extreme precipitation (relative to no precipitation) on daily AAD hospitalizations lasted from lag 5 [relative risk (RR): 1.0318, 95% confidence interval (CI): 1.0067-1.0575] to lag 9 (RR: 1.0297, 95% CI: 1.0045-1.0555) and reached its maximum at lag 7 (RR: 1.0382, 95% CI: 1.0105-1.0665). Males and older adult individuals (≥60 years) were more susceptible to extreme precipitation. A total of 3.68% (118 cases) of AAD hospitalizations were due to extreme precipitation.

Conclusion

Extreme precipitation was significantly correlated with AAD hospitalizations. Government departments should actively implement extreme precipitation intervention measures to strengthen the protection of males and the older adult (≥60 years) and effectively reduce AAD hospitalizations.

Misdiagnosis of aortic dissection: A systematic review of the literature

BACKGROUND

Aortic dissection is a rare but potentially catastrophic condition. Misdiagnosis of aortic dissection is not uncommon as symptoms can overlap with other diagnoses.

OBJECTIVE

We conducted a systematic review to better understand the factors contributing to incorrect diagnosis of this condition.

METHODS

We searched MEDLINE and EMBASE for studies that evaluated the misdiagnosis of aortic dissection. The rate of misdiagnosis was pooled and results were narratively synthesized.

RESULTS

A total of 12 studies with were included with 1663 patients. The overall rate of misdiagnosis of aortic dissection was 33.8%. The proportion of patients presenting with chest pain, back pain and syncope were 67.5%, 24.8% and 6.8% respectively. The proportion of patients with pre-existing hypertension was 55.4%, 30.5% were smokers while the proportion of patients with coronary artery disease, previous cardiovascular surgery or surgical trauma and Marfan syndrome was 14.7%, 5.8%, and 3.7%, respectively. Factors related to misdiagnosis included the presence of symptoms and features associated with other diseases (such as acute coronary syndrome, stroke and pulmonary embolism), the absence of typical features (such as widened mediastinum on chest X-ray) or concurrent conditions such congestive heart failure. Factors associated with more accurate diagnosis included more comprehensive history taking and increased use of imaging.

CONCLUSIONS

Misdiagnosis in patients with an eventual diagnosis of aortic dissection affects 1 in 3 patients. Clinicians should consider aortic dissection as differential diagnosis in patients with chest pain, back pain and syncope. Imaging should be used early to make the diagnosis when aortic dissection is suspected.