Emergency Department, Karolinska University Hospital Stockholm, Stockholm, Sweden.
Department of Vascular Surgery, Karolinska University Hospital Stockholm, Stockholm, Sweden.
Scand J Trauma Resusc Emerg Med. 2024 Sep 23;32(1):94. doi: 10.1186/s13049-024-01268-0.
Misdiagnosis of ruptured abdominal aortic aneurysms (rAAA) contributes to delayed treatment and potentially higher mortality. The symptomatology in patients with rAAA is complex and challenging, 25-50% presumably fulfill the criteria of the standard triad of signs (STS). The objective was to determine the initial signs registered for patients with verified rAAAs, and to investigate if an expanded diagnostic triad could increase the diagnostic accuracy.
A population-based study was conducted among all patients presenting with verified rAAAs in Stockholm County, Sweden, from January 2010 to October 2021. Patients were identified with ICD code 171.3 (rAAA). The STS was defined as (1) abdominal pain, (2) syncope and (3) the finding of a pulsatile abdominal mass, the prevalence of STS was investigated. An expanded triad included similar and related signs commonly registered for patients with rAAA, and was referred to as the modified abdominal aortic aneurysm rupture signs (MARS). The MARS-signs encompassed (1) the registered pain-associated symptoms or signs, (2) all hypovolemic associated signs, and (3) pulsatile abdominal mass and/or ultrasound finding, and the prevalence was similarly investigated. Finally, the STS and MARS were compared to evaluate the usefulness and performance of the MARS-score.
A total of 216 patients were identified. The majority were men (77%) with a median age of 78 years. The dominating symptom was abdominal pain (84%), followed by dizziness (50%). Few patients presented with three STS (13%), two STS were found in 37% and one STS in almost half of the patients (41%). By contrast, when applying MARS 35% presented with the complete expanded triad, 47% with two and 17% with one. Comparison of accuracy favored MARS (13 vs. 35% with 3 signs, P < 0.001 for STS vs. MARS) (2 or 3 signs, 48 vs. 82% STS vs. MARS, P < 0.001).
The expanded MARS-signs could aid in easier and faster identification of rAAA patients, thus facilitating the first step with accurate diagnosis into the lifesaving rAAA care chain. Supportive diagnostic mnemonics and tools are especially important when targeting fatal diagnoses such as rAAA. Further studies are needed to investigate the implementation of the MARS-signs in various clinical settings.
破裂性腹主动脉瘤（rAAA）的误诊导致治疗延误，死亡率升高。rAAA 患者的症状复杂且具有挑战性，25-50%的患者可能符合标准三联征（STS）的标准。目的是确定经证实的 rAAA 患者的初始体征，并研究扩大的诊断三联征是否能提高诊断准确性。
这是一项基于人群的研究，纳入了 2010 年 1 月至 2021 年 10 月在瑞典斯德哥尔摩县就诊的所有经证实的 rAAA 患者。患者通过 ICD 编码 171.3（rAAA）进行识别。STS 定义为（1）腹痛，（2）晕厥和（3）发现搏动性腹部肿块，研究了 STS 的发生率。扩展三联征包括通常为 rAAA 患者记录的类似和相关体征，并称为改良腹主动脉瘤破裂体征（MARS）。MARS 体征包括（1）记录的疼痛相关症状或体征，（2）所有低血容量相关体征，和（3）搏动性腹部肿块和/或超声发现，同样研究了其发生率。最后，将 STS 和 MARS 进行比较，以评估 MARS 评分的有用性和性能。
共确定了 216 名患者。大多数患者为男性（77%），中位年龄为 78 岁。最常见的症状是腹痛（84%），其次是头晕（50%）。少数患者出现三联征（13%），两联征（37%），近半数患者（41%）出现一联征。相比之下，当应用 MARS 时，35%的患者出现完全扩展三联征，47%的患者出现两联征，17%的患者出现一联征。准确性比较有利于 MARS（3 个体征组为 13%，3 个体征组 STS 与 MARS 相比，P<0.001；2 或 3 个体征组为 48%，STS 与 MARS 相比，P<0.001）。
扩展的 MARS 体征有助于更容易和更快地识别 rAAA 患者，从而促进准确诊断进入救生 rAAA 护理链的第一步。针对致命诊断（如 rAAA）时，辅助诊断记忆术和工具尤为重要。需要进一步的研究来探讨 MARS 体征在各种临床环境中的应用。
