Aortic dissection diagnosis delay concerns

Nearly a fifth of patients with aortic dissection (AD) die before reaching hospital and half die before reaching a specialist centre, according to a report by the Healthcare Safety Investigation Branch (https://www.hsib.org.uk/investigations-cases/delayed-recognition-acute-aortic-dissection/final-report/).

The report on delayed recognition of acute AD was prompted by a case investigation into the death of a 54-year old man who fell ill during while exercising at the gym. A delay of five hours occurred before a diagnosis was made, but he died while being transported to a specialist centre. The report analysed hospital activity and other national datasets and found that AD may occur in around 4.5 per 100 000 of the population per year, equal to around 2500 cases per year in England. Men are up to three times more likely to suffer AD than women.
It showed that a delay in diagnosis occurs in around 16–40% of cases and is more likely if patients walk in to the hospital rather than are stretchered in, or if doctors initially suspect that there is a cardiac cause for chest pain.

The report highlights the fact that acute AD is a rare cause of chest pain, particularly in comparison with acute myocardial infarction, but that it requires rapid treatment. As the most common symptoms of acute AD are generalised chest and back pain, and it is not easy to identify on x-ray images, clinicians can easily miss the condition, it says.

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