Xiao Yaru, Huang Sufang, Zheng Danli, Li Ying, Ke Jian, Lang Xiaorong, Feng Danni
Emergency Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China.
Nursing Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China.
Rev Cardiovasc Med. 2025 Jun 25;26(6):33487. doi: 10.31083/RCM33487. eCollection 2025 Jun.
Patients with aortic dissection (AD) exhibit an elevated early mortality rate. A timely diagnosis is essential for successful management, but this is challenging. There are limited data delineating the factors contributing to a delayed diagnosis of AD. We conducted a scoping review to assess the time to diagnosis and explore the risk factors associated with a delayed diagnosis.
This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted online searches in PubMed, Web of Science, Cochrane Library, Bing, Wanfang Data Chinese database, and the China National Knowledge Infrastructure (CNKI) Chinese database for studies that evaluated the diagnostic time and instances of delayed diagnoses of AD.
A total of 27 studies were retrieved from our online searches and included in this scoping review. The time from symptom onset to diagnosis ranged from 40.5 min to 84.4 h, and the time from hospital presentation to diagnosis ranged from 0.5 h to 25 h. Multiple factors resulted in a significantly delayed diagnosis. Demographic and medical history predictors of delayed diagnosis included the female sex, age, North American versus European geographic location, initial AD, history of congestive heart failure, history of hyperlipidemia, distressed communities index >60, walk-in visits to the emergency department, those who transferred from a non-tertiary care hospital, and preoperative coronary angiography. Furthermore, chest and back pain, especially abrupt or radiating pain, low systolic blood pressure, pulse deficit, and malperfusion syndrome required less time for diagnostic confirmation. In contrast, painlessness, syncope, fever, pleural effusion, dyspnea, troponin positivity, and acute coronary syndrome-like electrocardiogram were more prevalent in patients with a delayed diagnosis.
A recognition of the features associated with both typical and atypical presentations of AD is useful for a rapid diagnosis. Educational efforts to improve clinician awareness of the various presentations of AD and, ultimately, improve AD recognition may be relevant, particularly in non-tertiary hospitals with low exposure to aortic emergencies.
主动脉夹层（AD）患者早期死亡率较高。及时诊断对于成功治疗至关重要，但颇具挑战性。关于导致AD诊断延迟的因素的数据有限。我们进行了一项范围综述，以评估诊断时间并探索与诊断延迟相关的风险因素。
本范围综述按照系统评价与Meta分析的首选报告项目（PRISMA）指南进行。我们在PubMed、科学网、Cochrane图书馆、必应、万方数据中文数据库和中国知网中文数据库中进行在线搜索，以查找评估AD诊断时间和诊断延迟情况的研究。
通过在线搜索共检索到27项研究并纳入本范围综述。从症状出现到诊断的时间为40.5分钟至84.4小时，从入院到诊断的时间为0.5小时至25小时。多种因素导致诊断显著延迟。诊断延迟的人口统计学和病史预测因素包括女性、年龄、北美与欧洲地理位置、首发AD、充血性心力衰竭病史、高脂血症病史、社区困境指数>60、急诊室非预约就诊、从非三级医院转诊而来的患者以及术前冠状动脉造影。此外，胸痛和背痛，尤其是突发或放射性疼痛、收缩压降低、脉搏缺损和灌注不良综合征确诊所需时间较短。相比之下，无痛、晕厥、发热、胸腔积液、呼吸困难、肌钙蛋白阳性以及急性冠状动脉综合征样心电图在诊断延迟的患者中更为常见。
认识到AD典型和非典型表现相关的特征有助于快速诊断。开展教育活动以提高临床医生对AD各种表现的认识，并最终提高对AD的识别能力可能具有重要意义，尤其是在主动脉急症接触较少的非三级医院。
