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Risk factors for diagnostic delay in acute aortic dissection
Claudio Rapezzi1, Simone Longhi, Maddalena Graziosi
1Institute of Cardiology, University of Bologna and S Orsola-Malpighi Hospital, Bologna, Italy. claudio.rapezzi@unibo.it
The American Journal of Cardiology
|November 11, 2008
Summary
Timely diagnosis of acute aortic dissection (AAD) is crucial. This study reveals that most diagnostic delays for AAD occur within the hospital, not before arrival.
Area of Science:
- Cardiovascular Medicine
- Emergency Medicine
- Diagnostic Imaging
Background:
- Acute aortic dissection (AAD) presents diagnostic challenges.
- Limited research exists on diagnostic delays and their determinants in AAD.
- Timely diagnosis is critical for improving patient outcomes in AAD.
Purpose of the Study:
- To investigate pre-hospital and in-hospital times to diagnosis for AAD.
- To identify risk factors associated with diagnostic delays in AAD.
- To analyze trends in diagnostic times over the years.
Main Methods:
- Analysis of a metropolitan AAD network database (161 patients, 115 Stanford type A).
- Comparison of hospital arrival times (pain to hospital) and in-hospital diagnostic times (presentation to diagnosis).
- Univariate analysis of risk factors for prolonged in-hospital diagnostic times (>75th percentile).
Main Results:
- In-hospital diagnostic times were significantly longer (median 177 min) than hospital arrival times (median 75 min).
- Median annual in-hospital diagnostic times decreased after 2001.
- Risk factors for longer in-hospital delays included pleural effusion, dyspneic presentation, and age <70 years. Hypotension and younger age were associated with shorter delays.
Conclusions:
- The majority of diagnostic delay in acute aortic dissection occurs within the hospital setting.
- Clinical factors such as pleural effusion, dyspnea, troponin positivity, and ACS-like ECG can confound diagnosis and prolong in-hospital times.
- Strategies to reduce in-hospital diagnostic delays are essential for improving AAD management.
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