Prospective study on factors delaying surgery in ruptured abdominal aortic aneurysms

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Diagnostic Imaging

Background:

• Delays in diagnosing and treating abdominal aortic aneurysms (AAAs) significantly impact patient outcomes.
• Understanding the reasons behind these delays is crucial for improving management strategies.

Purpose of the Study:

• To investigate the causes of delays in the management of ruptured abdominal aortic aneurysms (AAAs).
• To assess the diagnostic accuracy of general practitioners and non-vascular hospital doctors in suspected ruptured AAA cases.
• To evaluate the impact of ultrasound scanning on referral times to vascular units.

Main Methods:

• Prospective study involving 30 patients diagnosed with ruptured AAAs.
• Analysis of diagnostic accuracy by general practitioners and non-vascular hospital physicians.
• Assessment of referral times and diagnostic utility of ultrasound scans.

Main Results:

• General practitioners correctly diagnosed only 38% of ruptured AAA cases; renal colic was a common misdiagnosis.
• Non-vascular hospital doctors achieved 55% correct diagnosis rate; back pain was frequently misdiagnosed.
• Ultrasound scans delayed referral to vascular services (median 0.75 to 2.50 hours) with limited diagnostic benefit.

Conclusions:

• High rates of misdiagnosis by primary care and non-specialist hospital physicians are significant factors in delayed AAA management.
• Ultrasound scanning, in this context, did not expedite diagnosis and contributed to delays in accessing specialized vascular care.
• Improving diagnostic accuracy and streamlining referral pathways are essential for better outcomes in ruptured AAA patients.