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High Risk Clinical Features for Acute Aortic Dissection: A Case-Control Study.

Robert Ohle1, Justin Um2, Omar Anjum2

  • 1Department of Emergency Medicine, the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|December 9, 2017
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Summary
This summary is machine-generated.

Acute aortic dissection (AAD) is often missed, but absence of abrupt-onset pain rules it out. Specific symptoms like tearing pain and pulse deficits help confirm AAD diagnosis.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Diagnostic Accuracy

Background:

  • Acute aortic dissection (AAD) is a rare but life-threatening condition frequently misdiagnosed.
  • Early and accurate diagnosis is critical for improving patient outcomes.

Purpose of the Study:

  • To evaluate the diagnostic utility of clinical and laboratory findings for acute aortic dissection.
  • To differentiate between confirmed AAD cases and a low-risk control group.

Main Methods:

  • A matched case-control study involving adults presenting to emergency departments.
  • 194 AAD cases were matched with 776 controls (1:4 ratio) based on age and sex.
  • Data collected retrospectively from 2002 to 2014.

Main Results:

  • Absence of abrupt-onset pain demonstrated high sensitivity (95.9%) for ruling out AAD.
  • Key indicators for ruling in AAD include tearing/ripping pain (LR+ 42.1), pulse deficit (LR+ 31.1), and hypotension (LR+ 17.2).
  • Other significant findings include aortic aneurysm, neurologic deficits, and new murmurs.

Conclusions:

  • Patients presenting with one or more high-risk features should be considered at high risk for AAD.
  • Conversely, individuals with no high-risk features and multiple low-risk indicators are likely at low risk for AAD.