Rosman H S, Patel S, Borzak S, Paone G, Retter K
Henry Ford Heart and Vascular Institute, Henry Ford Health System, Detroit, USA.
Chest. 1998 Sep;114(3):793-5. doi: 10.1378/chest.114.3.793.
Aortic dissection generally is an acute catastrophe. Rapid diagnosis is critical. We hypothesized that the quality of history taking contributes to the accuracy of diagnosis in patients with dissection.
Retrospective chart review of 83 patients, whose diagnosis of aortic dissection was confirmed by autopsy, surgery, CT scan, echocardiogram, or angiogram. The quality of the initial history was reviewed using predetermined criteria. The physicians' initial clinical impressions were recorded.
The examining physician correctly suspected aortic dissection after the initial clinical evaluation in 54 of 83 patients (65%). Only 33 of 78 patients with symptoms (42%) were asked about the quality, location, and onset of their pain, the three descriptors identified a priori as important. In 19 patients (24%), only zero or one descriptor was recorded. When all three questions were asked, dissection was suspected in 30 of 33 patients (91%); when zero, one, or two questions were asked, dissection was suspected in 22 of 45 patients (49%).
Despite important advances in diagnostic imaging, accurate diagnosis of aortic dissection requires an accurate history. In our series, the quality of initial history was associated with the accuracy of the initial clinical impression in patients with aortic dissection.
主动脉夹层通常是一种急性灾难性疾病。快速诊断至关重要。我们推测病史采集的质量有助于提高夹层患者诊断的准确性。
对83例患者进行回顾性病历审查，这些患者的主动脉夹层诊断经尸检、手术、CT扫描、超声心动图或血管造影证实。使用预先确定的标准对初始病史的质量进行审查。记录医生的初始临床印象。
在83例患者中，有54例（65%）在初始临床评估后被检查医生正确怀疑为主动脉夹层。在78例有症状的患者中，只有33例（42%）被询问了疼痛的性质、部位和发作情况，这三个描述词被预先确定为重要信息。在19例患者（24%）中，仅记录了零个或一个描述词。当询问了所有三个问题时，33例患者中有30例（91%）被怀疑为夹层；当询问了零个、一个或两个问题时，45例患者中有22例（49%）被怀疑为夹层。
尽管诊断成像取得了重要进展，但主动脉夹层的准确诊断仍需要准确的病史。在我们的系列研究中，初始病史的质量与主动脉夹层患者初始临床印象的准确性相关。
