Joseph Epstein Centre for Emergency Medicine Research, Western Health, Sunshine Hospital, Melbourne, Victoria, Australia.
Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
Emerg Med Australas. 2023 Feb;35(1):176-180. doi: 10.1111/1742-6723.14127. Epub 2022 Nov 6.
Aortic dissection (AD) is rare. Missed AD is a common reason for coronial investigations and civil claims for medical negligence. Recommendations include improved education, supervision and information transfer, reminders in chest pain pathways and higher rates of investigation for AD. Higher investigation rates pose risks to patients and the health system which may not be in balance with the likelihood of AD. The appropriate diagnostic yield of investigation to balance risk and benefit has not been defined. The AD detection risk score pathway has been proposed as a useful diagnostic tool but concerns about its derivation, validation and utility remain. In this paper, we try to draw together published literature and local audit data to develop recommendations about what might be done to reduce the number of missed AD cases in EDs and what the impact of higher investigation rates might be.
主动脉夹层 (AD) 较为罕见。漏诊 AD 是尸检调查和医疗过失民事索赔的常见原因。建议包括改进教育、监督和信息传递、胸痛路径中的提醒以及更高的 AD 调查率。更高的调查率会给患者和医疗体系带来风险，而这些风险与 AD 的可能性可能并不平衡。尚未确定调查的适当诊断收益，以平衡风险和收益。AD 检测风险评分途径已被提议作为一种有用的诊断工具，但对其推导、验证和实用性仍存在担忧。在本文中，我们试图结合已发表的文献和本地审核数据，就如何减少急诊科漏诊 AD 的数量以及更高的调查率可能产生的影响提出建议。
