Division of Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida.
Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Florida.
Ann Thorac Surg. 2022 Dec;114(6):2202-2208. doi: 10.1016/j.athoracsur.2021.11.006. Epub 2021 Nov 25.
Acute aortic syndromes (AASs) are prone to misdiagnosis by facilities with limited diagnostic experience. We assessed long-term trends in misdiagnosis among patients transferred to a tertiary care facility with presumed AASs.
Our institutional transfer center database was queried for emergency transfers in patients with a diagnosis of AASs or thoracic aortic aneurysm between January 2008 and May 2018. There were 784 patients classified as emergency transfer for presumed AAS. Transferring diagnosis and actual diagnosis were compared through a review of physician notes and radiology reports from referring facilities and our center.
Mean age was 62 years, with 478 (61%) men. Differences in transferring diagnosis and actual diagnosis were identified in 89 patients (11.4%). Among misdiagnosed patients, the wrong classification of Stanford type A or type B dissections was identified among 24 patients (27%). No dissection was found in 23 patients (26%) with a referring diagnosis of aortic dissection. No signs of rupture were found in 18 patients (20%) transferred for contained/impending rupture. All misdiagnoses were secondary to misinterpretation of radiographic imaging, with motion artifacts in 14 (16%) and postsurgical changes in 22 (25%) being common sources of diagnostic error. Repeat scans were performed in 64 patients (72%) at our facility due to limited access to or suboptimal quality of outside imaging.
Although AASs misdiagnosis rates appear to be improving from the prior decade, there are opportunities for improved physician awareness through campaigns such as "Think Aorta." Centralized web-based imaging may prevent the costly hazards of unnecessary emergency transfer.
急性主动脉综合征（AAS）在诊断经验有限的医疗机构中容易误诊。我们评估了转至一家具有三级护理能力的医疗机构的疑似 AAS 患者中误诊的长期趋势。
我们的机构转院中心数据库查询了 2008 年 1 月至 2018 年 5 月期间诊断为 AAS 或胸主动脉瘤的患者的紧急转院情况。有 784 名患者被归类为疑似 AAS 的紧急转院。通过查阅转院医疗机构和本院的医生记录和放射学报告，比较转院诊断和实际诊断。
平均年龄为 62 岁，其中 478 例（61%）为男性。在 89 例（11.4%）患者中发现了转院诊断和实际诊断的差异。在误诊患者中，24 例（27%）Stanford 型 A 或 B 夹层的分类错误。23 例（26%）转院诊断为主动脉夹层，但未发现夹层。18 例（20%）转院为破裂/破裂的患者未发现破裂迹象。所有误诊均归因于影像学检查的错误解读，其中 14 例（16%）为运动伪影，22 例（25%）为手术后改变，是常见的诊断错误源。由于无法获得或外部影像学质量不佳，在我们医院对 64 例患者（72%）进行了重复扫描。
尽管 AAS 误诊率似乎较前十年有所改善，但通过“Think Aorta”等宣传活动，可以提高医生的认识，以避免不必要的紧急转院。集中式网络成像可以避免不必要的紧急转院所带来的昂贵风险。
