Bhat Sameer, Bir Shreya, Schreve Franco, Bergin Colleen J, Jones Peter G, Waqanivavalagi Steve W F R
Departments of Surgery (S. Bhat, P.G.J.) and Medicine (S.W.F.R.W.), The University of Auckland, Auckland, New Zealand; Department of Surgery, University of Otago, Dunedin, New Zealand (S. Bir); and Adult Emergency Department (F.S., P.G.J., S.W.F.R.W.), Department of Radiology (C.J.B.), and Green Lane Cardiothoracic Surgical Unit (S.W.F.R.W.), Auckland City Hospital, Auckland District Health Board, 85 Park Rd, Grafton, Auckland 1142, New Zealand.
Radiol Cardiothorac Imaging. 2022 Nov 17;4(6):e220018. doi: 10.1148/ryct.220018. eCollection 2022 Dec.
To determine whether CT aortography was performed in proportion to patient risk for acute aortic syndrome (AAS) and incidence of AAS for different ethnic groups.
All atraumatic thoracic aorta CT aortographic examinations performed in adults (age > 15 years) suspected of having AAS between January 2009 and December 2019 at Auckland City Hospital (New Zealand) were included. Patients were risk stratified using the aortic dissection detection risk score (ADD-RS). The primary outcomes were the ratio of CT aortography rates to rates of positive CT aortographic examinations and the incidence of AAS. Population census data were used to determine age-standardized incidence of AAS in the emergency department (ED).
In total, 1646 CT aortographic examinations were performed in 1543 patients (mean age, 62 years ± 16 [SD]; 877 male patients). Māori (34% [68 of 203]) and Pacific Islanders (35% [80 of 229]) were more likely to be at high risk of AAS (ADD-RS > 1) compared with patients from other ethnic groups (25% [308 of 1214]); in the ED catchment population, age-standardized AAS incidence was significantly higher in Māori (6.9 per 100 000 person-years [95% CI: 4.3, 10.4]) and Pacific Islanders (5.3 [95% CI: 3.4, 7.8]) than in other ethnic groups (2.3 [95% CI: 1.8, 2.8]). Despite this higher incidence, disproportionately fewer CT aortographic examinations were requested in the ED for Māori (9.2 CT aortographic examinations per AAS diagnosis) and Pacific Islanders (9.2 CT aortographic examinations per AAS diagnosis) compared with other ethnic groups (13.8 CT aortographic examinations per AAS diagnosis).
Māori and Pacific Islanders were at disproportionately higher risk of AAS but had fewer requested CT aortographic examinations compared with other ethnic groups. This increased risk of AAS in Pacific Islander and indigenous Māori patients should be considered by clinicians when investigating AAS. Ethnicity, Māori, Pacific Islander, Aortic Dissection Detection Risk Score, Acute Aortic Syndrome, Aortic Dissection, CT Angiography © RSNA, 2022.
确定CT主动脉造影检查的实施比例是否与急性主动脉综合征（AAS）患者的风险以及不同种族AAS的发病率成比例。
纳入2009年1月至2019年12月在奥克兰市医院（新西兰）对疑似患有AAS的成人（年龄>15岁）进行的所有非创伤性胸主动脉CT主动脉造影检查。使用主动脉夹层检测风险评分（ADD-RS）对患者进行风险分层。主要结局是CT主动脉造影检查率与CT主动脉造影检查阳性率的比值以及AAS的发病率。利用人口普查数据确定急诊科（ED）中AAS的年龄标准化发病率。
共对1543例患者（平均年龄62岁±16[标准差]；877例男性患者）进行了1646次CT主动脉造影检查。与其他种族的患者（25%[1214例中的308例]）相比，毛利人（34%[203例中的68例]）和太平洋岛民（35%[229例中的80例]）患AAS的高风险可能性更高；在ED服务人群中，毛利人（每10万人年6.9例[95%可信区间：4.3，10.4]）和太平洋岛民（5.3例[95%可信区间：3.4，7.8]）的年龄标准化AAS发病率显著高于其他种族（2.3例[95%可信区间：1.8，2.8]）。尽管发病率较高，但与其他种族（每例AAS诊断13.8次CT主动脉造影检查）相比，急诊科为毛利人（每例AAS诊断9.2次CT主动脉造影检查）和太平洋岛民（每例AAS诊断9.2次CT主动脉造影检查）申请的CT主动脉造影检查比例不成比例地更少。
与其他种族相比，毛利人和太平洋岛民患AAS的风险不成比例地更高，但申请的CT主动脉造影检查更少。临床医生在调查AAS时应考虑太平洋岛民和毛利原住民患者AAS风险的增加。种族；毛利人；太平洋岛民；主动脉夹层检测风险评分；急性主动脉综合征；主动脉夹层；CT血管造影 ©RSNA，2022年
