Related Experiment Video
Updated: Apr 26, 2026
Manufacturing Abdominal Aorta Hydrogel Tissue-Mimicking Phantoms for Ultrasound Elastography Validation
Published on: September 19, 2018
Misdiagnosis of ruptured abdominal aortic aneurysm: systematic review and meta-analysis
Bilal Azhar1, Shaneel R Patel, Peter J E Holt
1Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK.
Purpose:
To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect differential diagnoses.
Methods:
A systematic search according to PRISMA guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting the initial rate of misdiagnosis of patients with rAAA. Random-effects meta-analyses were performed to estimate the rate of misdiagnosis, presenting features, and commonest differential diagnoses. A sensitivity analysis was performed for studies reporting after 1990.
Results:
Nine studies comprising 1109 patients contributed to the pooled analysis, which found a 42% incidence of rAAA misdiagnosis (95% CI 29% to 55%). In studies reporting after 1990, misdiagnosis was seen in 32% (95% CI 16% to 49%). The most common erroneous differential diagnoses were ureteric colic and myocardial infarction. Abdominal pain, shock, and a pulsatile mass were presenting features in 61% (49%-72%), 46% (32%-61%), and 45% (29%-62%) of rAAAs, respectively.
Conclusion:
The rate of misdiagnosis of rAAA has remained consistent over time and is concerning. There is a need for an effective clinical decision tool to enable accurate diagnosis and triage at the scene of the emergency.
Insights
Misdiagnosis of ruptured abdominal aortic aneurysms (rAAA) occurs in 42% of cases, with similar rates over time. Key symptoms include abdominal pain and shock, often mistaken for other conditions.
Area of Science:
- Medical Diagnostics
- Vascular Surgery
- Emergency Medicine
Background:
- Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition.
- High mortality rates are associated with delayed diagnosis and treatment.
- Accurate and timely diagnosis is critical for patient survival.
Purpose of the Study:
- To quantify the incidence of misdiagnosis in patients with rAAA.
- To identify the most frequent presenting features of rAAA.
- To determine the common incorrect differential diagnoses for rAAA.
Main Methods:
- Systematic literature search using EMBASE and MEDLINE databases.
- PRISMA guidelines followed for study selection.
- Random-effects meta-analysis to pool data on misdiagnosis rates, presenting features, and differential diagnoses.
Main Results:
- A pooled analysis of 9 studies (1109 patients) revealed a 42% incidence of rAAA misdiagnosis.
- In studies published after 1990, the misdiagnosis rate was 32%.
- Common misdiagnoses included ureteric colic and myocardial infarction; key presenting features were abdominal pain (61%), shock (46%), and pulsatile mass (45%).
Conclusions:
- The consistent and high rate of rAAA misdiagnosis is a significant concern.
- There is a critical need for improved clinical decision support tools for emergency diagnosis and triage.
- Enhanced diagnostic strategies are required to reduce mortality associated with rAAA.
