John A. Burns School of Medicine, 651 Ilalo St, Honolulu, HI, 96813, USA.
Punahou School, 1601 Punahou St, Honolulu, HI, 96822, USA.
Emerg Radiol. 2022 Aug;29(4):709-713. doi: 10.1007/s10140-022-02054-0. Epub 2022 May 5.
This study was performed to investigate the variation in CTA imaging for AoD in an ED to determine if limiting the scanned region to the chest can effectively rule-out AoD without delaying care.
A retrospective chart review was performed for all patients belonging to a geographically isolated health maintenance organization who underwent CTA evaluation for possible acute AoD in the emergency department between 2016 and 2020. We evaluated for the regions included in the CTA, the presence of an acute AoD, and clinical outcomes. For those who were ruled-out of an AoD with a CTA limited to the chest, we investigated clinical follow-up up to 6 months after their initial presentation.
Over the study period, there were 1143 CT scans ordered by ED physicians to evaluate for AoD in patients without a history of AoD. Only 23.0% of screening studies were of the chest only. There were 29 acute AoDs diagnosed (14 type A and 15 type B) making for a prevalence of 2.5%. Only one patient with an acute AoD detected on a chest-only CTA required farther imaging, which did not delay clinical care. No patients ruled-out for acute AoD with a chest-only CTA had a return ED visit or repeat CTA within 6 months diagnosing a missed AoD. There were no AoDs limited to the abdominal aorta that would have been missed on a chest-only study.
In patients in the ED with suspected new acute AoD, a CTA limited to the chest can effectively evaluate the condition without delaying care in this integrated healthcare system with 24/7 CT availability.
本研究旨在探讨急诊科急性主动脉夹层（AoD）患者 CTA 成像的变化，以确定仅扫描胸部是否可以有效地排除 AoD 而不延迟治疗。
对 2016 年至 2020 年间在急诊科因疑似急性 AoD 接受 CTA 评估的、来自地理位置孤立的健康维护组织的所有患者进行回顾性图表审查。我们评估了 CTA 包括的区域、急性 AoD 的存在以及临床结局。对于那些 CTA 仅局限于胸部而排除 AoD 的患者，我们调查了他们在初次就诊后 6 个月的临床随访情况。
在研究期间，急诊科医生为评估无 AoD 病史的患者进行了 1143 次 CT 扫描以排除 AoD。仅有 23.0%的筛选研究仅为胸部 CT。共诊断出 29 例急性 AoD（14 型 A 和 15 型 B），患病率为 2.5%。仅 1 例急性 AoD 患者在胸部 CT 上检测到 AoD 需要进一步影像学检查，但并未延迟临床治疗。在胸部 CT 排除急性 AoD 的患者中，无 6 个月内返回急诊科就诊或重复 CTA 诊断漏诊 AoD。在仅进行胸部 CT 检查的情况下，不会漏诊局限于腹主动脉的 AoD。
在急诊科疑似新发急性 AoD 的患者中，在 24/7 具备 CT 检查的综合性医疗体系中，仅行胸部 CTA 即可有效地评估病情而不延迟治疗。
