The risk of misdiagnosis in acute thoracic aortic dissection: a review of current guidelines

医学 主动脉夹层 胸主动脉 电流(流体) 主动脉瘤 放射科 重症监护医学 心脏病学 动脉瘤 主动脉 电气工程 工程类
作者
M. Yousuf Salmasi,Nina Al-Saadi,Philip Hartley,Omar A. Jarral,Shahzad G. Raja,Muthana Hussein,Julian Redhead,Ulrich Rosendahl,Christoph Nienaber,John Pepper,Aung Oo,Thanos Athanasiou
出处
期刊:Heart [BMJ]
卷期号:106 (12): 885-891 被引量:48
标识
DOI:10.1136/heartjnl-2019-316322
摘要

Acute aortic syndrome and in particular aortic dissection (AAD) persists as a cause of significant morbidity and mortality despite improvements in surgical management. This clinical review aims to explore the risks of misdiagnosis, outcomes associated with misdiagnosis and evaluate current diagnostic methods for reducing its incidence.Due to the nature of the pathology, misdiagnosing the condition and delaying management can dramatically worsen patient outcomes. Several diagnostic challenges exist, including low prevalence, rapidly propagating pathology, non-discrete symptomatology, non-specific signs, analogy with other acute conditions and lack of management infrastructure. A similarity to acute coronary syndromes is a specific concern and risks patient maltreatment. AAD with malperfusion syndromes are both a cause of misdiagnosis and marker of disease complication, requiring specifically tailored management plans from the emergency setting.Despite improvements in diagnostic measures, including imaging modalities and biomarkers, misdiagnosis of AAD remains commonplace and current guidelines are relatively limited in preventing its occurrence. This paper recommends the early use of AAD risk scoring, focused echocardiography and most importantly, fast-tracking patients to cross-sectional imaging where the suspicion of AAD is high. This has the potential to improve the diagnostic process for AAD and limit the risk of misdiagnosis. However, our understanding remains limited by the lack of large patient datasets and an adequately audited processes of emergency department practice.
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