Azhar Bilal, Patel Shaneel R, Holt Peter J E, Hinchliffe Robert J, Thompson Matt M, Karthikesalingam Alan
Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK.
J Endovasc Ther. 2014 Aug;21(4):568-75. doi: 10.1583/13-4626MR.1.
To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect differential diagnoses.
A systematic search according to PRISMA guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting the initial rate of misdiagnosis of patients with rAAA. Random-effects meta-analyses were performed to estimate the rate of misdiagnosis, presenting features, and commonest differential diagnoses. A sensitivity analysis was performed for studies reporting after 1990.
Nine studies comprising 1109 patients contributed to the pooled analysis, which found a 42% incidence of rAAA misdiagnosis (95% CI 29% to 55%). In studies reporting after 1990, misdiagnosis was seen in 32% (95% CI 16% to 49%). The most common erroneous differential diagnoses were ureteric colic and myocardial infarction. Abdominal pain, shock, and a pulsatile mass were presenting features in 61% (49%-72%), 46% (32%-61%), and 45% (29%-62%) of rAAAs, respectively.
The rate of misdiagnosis of rAAA has remained consistent over time and is concerning. There is a need for an effective clinical decision tool to enable accurate diagnosis and triage at the scene of the emergency.
定量总结腹主动脉瘤破裂（rAAA）的误诊发生率、最常见的临床表现以及最常见的错误鉴别诊断。
根据PRISMA指南，使用EMBASE和MEDLINE数据库进行系统检索，以确定报告rAAA患者初始误诊率的研究。进行随机效应荟萃分析，以估计误诊率、临床表现和最常见的鉴别诊断。对1990年后报告的研究进行敏感性分析。
9项研究共纳入1109例患者，纳入汇总分析后发现rAAA误诊发生率为42%（95%CI 29%至55%）。在1990年后报告的研究中，误诊率为32%（95%CI 16%至49%）。最常见的错误鉴别诊断是输尿管绞痛和心肌梗死。腹痛、休克和搏动性肿块分别在61%（49%-72%）、46%（32%-61%）和45%（29%-62%）的rAAA患者中出现。
rAAA的误诊率长期保持稳定，令人担忧。需要一种有效的临床决策工具，以便在紧急情况下进行准确诊断和分诊。
