Institute of Physiology, Charité - Universitätsmedizin Berlin, Germany.
Institute for Anaesthesiology, German Heart Center Berlin, Germany.
Eur Heart J Acute Cardiovasc Care. 2020 Oct;9(3_suppl):S40-S47. doi: 10.1177/2048872620914931. Epub 2020 Mar 30.
Acute type A aortic dissection requires immediate surgical treatment, but the correct diagnosis is often delayed. This study aimed to analyse how initial misdiagnosis affected the time intervals before surgical treatment, symptoms associated with correct or incorrect initial diagnosis and the potential of the Aortic Dissection Detection Risk Score to improve the sensitivity of initial diagnosis.
We conducted a retrospective analysis of 350 patients with acute type A aortic dissection. Patients were divided into two groups: initial misdiagnosis (group 0) and correct initial diagnosis of acute type A aortic dissection (group 1). Symptoms were analysed as predictors for the correct or incorrect initial diagnosis by multivariate analysis. Based on these findings, the Aortic Dissection Detection Risk Score was calculated retrospectively; a result ⩾2 was defined as a positive score.
The early suspicion of aortic dissection significantly shortened the median time from pain to surgical correction from 8.6 h in patients with an initial misdiagnosis to 5.5 h in patients with the correct initial diagnosis (<0.001). Of all acute type A aortic dissection patients, 49% had a positive Aortic Dissection Detection Risk Score. Of all initial misdiagnosed patients, 41% had a positive score (⩾2). The presence of lumbar pain (<0.001), any paresis (=0.037) and sweating (=0.042) was more likely to lead to the correct initial diagnosis.
An early consideration of acute aortic dissection may reduce the delay of surgical care. The suggested Aortic Dissection Detection Risk Score may be a useful tool to improve the preclinical assessment.
急性 A 型主动脉夹层需要立即进行手术治疗，但正确的诊断往往会被延迟。本研究旨在分析初始误诊如何影响手术治疗前的时间间隔、与正确或错误初始诊断相关的症状，以及主动脉夹层检测风险评分提高初始诊断敏感性的潜力。
我们对 350 例急性 A 型主动脉夹层患者进行了回顾性分析。患者分为两组：初始误诊（组 0）和急性 A 型主动脉夹层的正确初始诊断（组 1）。通过多变量分析，将症状分析为正确或错误初始诊断的预测因子。基于这些发现，回顾性计算了主动脉夹层检测风险评分；评分 ⩾2 定义为阳性评分。
主动脉夹层的早期怀疑显著缩短了从疼痛到手术矫正的中位时间，从初始误诊患者的 8.6 小时缩短到正确初始诊断患者的 5.5 小时（<0.001）。在所有急性 A 型主动脉夹层患者中，49%的患者主动脉夹层检测风险评分阳性。在所有初始误诊患者中，41%的患者评分阳性（⩾2）。存在腰痛（<0.001）、任何瘫痪（=0.037）和出汗（=0.042）更有可能导致正确的初始诊断。
早期考虑急性主动脉夹层可能会减少手术护理的延迟。建议的主动脉夹层检测风险评分可能是提高临床前评估的有用工具。
