Delayed Diagnosis of Aortic Dissection: A Scoping Review

Patients with aortic dissection (AD) exhibit an elevated early mortality rate. A timely diagnosis is essential for successful management, but this is challenging. There are limited data delineating the factors contributing to a delayed diagnosis of AD. We conducted a scoping review to assess the time to diagnosis and explore the risk factors associated with a delayed diagnosis.

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted online searches in PubMed, Web of Science, Cochrane Library, Bing, Wanfang Data Chinese database, and the China National Knowledge Infrastructure (CNKI) Chinese database for studies that evaluated the diagnostic time and instances of delayed diagnoses of AD.

A total of 27 studies were retrieved from our online searches and included in this scoping review. The time from symptom onset to diagnosis ranged from 40.5 min to 84.4 h, and the time from hospital presentation to diagnosis ranged from 0.5 h to 25 h. Multiple factors resulted in a significantly delayed diagnosis. Demographic and medical history predictors of delayed diagnosis included the female sex, age, North American versus European geographic location, initial AD, history of congestive heart failure, history of hyperlipidemia, distressed communities index >60, walk-in visits to the emergency department, those who transferred from a non-tertiary care hospital, and preoperative coronary angiography. Furthermore, chest and back pain, especially abrupt or radiating pain, low systolic blood pressure, pulse deficit, and malperfusion syndrome required less time for diagnostic confirmation. In contrast, painlessness, syncope, fever, pleural effusion, dyspnea, troponin positivity, and acute coronary syndrome-like electrocardiogram were more prevalent in patients with a delayed diagnosis.

A recognition of the features associated with both typical and atypical presentations of AD is useful for a rapid diagnosis. Educational efforts to improve clinician awareness of the various presentations of AD and, ultimately, improve AD recognition may be relevant, particularly in non-tertiary hospitals with low exposure to aortic emergencies.