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Variation in CTA evaluation of ED patients suspected of aortic dissection

Jarren K T Takaki1, Isabella Ford2, Hyo-Chun Yoon3

  • 1John A. Burns School of Medicine, 651 Ilalo St, Honolulu, HI, 96813, USA. jarrent@hawaii.edu.

Emergency Radiology
|May 5, 2022
PubMed

Insights

A chest-only CT angiography (CTA) effectively rules out acute aortic dissection (AoD) in emergency department patients. This approach avoids care delays and missed diagnoses in integrated healthcare systems.

Area of Science:

  • Emergency Medicine
  • Radiology
  • Vascular Surgery

Background:

  • Acute aortic dissection (AoD) is a life-threatening condition requiring prompt diagnosis.
  • Computed Tomography Angiography (CTA) is a primary imaging modality for AoD evaluation.
  • Variations in CTA scanning protocols may impact diagnostic accuracy and efficiency.

Purpose of the Study:

  • To investigate the diagnostic utility of chest-only CTA for acute AoD in the emergency department.
  • To determine if limiting CTA to the chest can effectively rule out AoD without delaying patient care.
  • To assess the impact of restricted CTA regions on clinical outcomes.

Main Methods:

  • Retrospective chart review of patients undergoing CTA for suspected AoD between 2016-2020.
  • Evaluation of CTA scan regions, AoD diagnosis, and clinical outcomes.
  • Analysis of follow-up data for patients with chest-only CTA ruling out AoD.

Main Results:

  • A prevalence of 2.5% for acute AoD (29 cases) was observed among 1143 evaluated patients.
  • Only 23.0% of initial screening CTAs were limited to the chest.
  • Chest-only CTA effectively ruled out AoD, with no missed diagnoses or significant care delays.

Conclusions:

  • A CTA limited to the chest is a safe and effective strategy for evaluating suspected acute AoD in the ED.
  • This protocol can expedite diagnosis and management without compromising patient safety.
  • Integrated healthcare systems with 24/7 CT availability can benefit from this streamlined approach.
Abstract

Keywords:
Aortic dissectionCTEmergency departmentRadiation dose

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