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La disección aórtica en la ED: una perspectiva médico-legal sobre retrasos y fallas en el diagnóstico
Jacqueline H Fortier1, Mehrnaz Mostafapour1, Robert Ohle2,3
1The Canadian Medical Protective Association, Ottawa, ON, Canada.
CJEM
|August 21, 2025
Resumen
El diagnóstico tardío de la disección aórtica en el departamento de emergencias (ED) a menudo se debe a problemas cognitivos, de comunicación y de sistemas. Abordar estos factores puede mejorar la precisión del diagnóstico y los resultados del paciente.
Área de la Ciencia:
- Medicina de emergencia
- Precisión del diagnóstico
- Malos tratos médicos
Sus antecedentes:
- La disección aórtica es una condición crítica con alta mortalidad.
- El retraso o la falta de diagnóstico conducen a graves daños en el paciente.
Objetivo del estudio:
- Analizar los casos médico-legales de disección de la aorta torácica en la sala de emergencia.
- Identificar los factores que contribuyen a los errores de diagnóstico.
- Evaluar el impacto potencial de las herramientas de decisión clínica.
Principales métodos:
- Análisis cuantitativo y cualitativo de 43 casos médico-legales durante 10 años.
- Análisis temático de las críticas de expertos sobre la calidad de la atención.
- Aplicación de dos herramientas de decisión clínica.
Principales resultados:
- La disección aórtica comprendió una pequeña fracción (43/3531) de los casos médico-legales de disfunción eréctil.
- Los problemas de diagnóstico comunes incluyen presentaciones atípicas, sesgos cognitivos, mal uso de las pruebas, fallas de comunicación y límites de recursos.
- La mayoría de los pacientes eran hombres, se presentaron en centros urbanos y fueron clasificados como urgentes/emergentes.
Conclusiones:
- Los diagnósticos de disección aórtica perdida provienen de factores cognitivos, de comunicación y a nivel del sistema combinados.
- Comprender estos factores es crucial para desarrollar estrategias para mejorar la precisión del diagnóstico.
- Las intervenciones a nivel de sistema basadas en la evidencia pueden reducir el daño al paciente por errores de diagnóstico.
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