J Korean Soc Emerg Med.  2012 Dec;23(6):784-790.

Diagnosis of Acute Aortic Dissection by the 2010 American Heart Association Guideline at Emergency Room: Analysis of a Delayed Diagnosis

• Park W
• Park CH
• Jeon YB
• Lee JI
• Choi CH
• Park KY
• Kim JJ
• Hyun SY
• Yang HJ
• Kim EY

Abstract

PURPOSE
Acute aortic dissection is a rare and life-threatening disease, requiring an immediate evaluation and treatment. In 2010, the American College of Cardiology/American Heart Association suggested a new risk score system for the detection of an acute aortic dissection. This system was applied to our known patients with acute aortic dissection.
METHODS
155 patients with acute aortic dissection regardless of the types from January 2000 to June 2012 were examined. The known risk factors and 12 newly proposed risk factors were compared, based on the new guidelines, after dividing them into a delayed diagnosis group and early diagnosis group. The impact of the aortic dissection detection (ADD) risk score on the diagnostic process was assessed.
RESULTS
The abrupt onset of pain was the most frequent symptom (65.2%) and only had an impact on an early diagnosis (p=0.021). 83 patients (53.5%) showed a widened mediastinum in the chest X-rays. The diagnosis was delayed in 21 patients (13.8%). According to the new guideline, 149(96.1%) were identified by 1 or more of the 12 clinical markers. 6(3.8%), 88(56.8%) and 61(39.3%) patients were classified as low, intermediate and high risk, respectively. Three of the 6 low risk patients showed mediastinal widening.
CONCLUSION
The clinical risk markers and the ADD risk score system in the 2010 guidelines detected patients with high sensitivity. The new risk score system appears to be a valuable diagnostic index at the initial presentation.

Keyword

Aortic dissection; Guideline; Delayed diagnosis

MeSH Terms

American Heart Association
Biomarkers
Delayed Diagnosis
Early Diagnosis
Emergencies
Heart
Humans
Mediastinum
Risk Factors
Thorax