Emergency physician focused cardiac ultrasound improves diagnosis of ascending aortic dissection

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• 作者：Joseph R. Pare ; MD^a ; ^{joseph.pare@yale.edu" class="auth_mail" title="E-mail the corresponding author} ; Rachel Liu ; MD^a ; Christopher L. Moore ; MD^a ; Tyler Sherban ; BA^b ; Michael S. Kelleher Jr. ; MD^c ; Sheeja Thomas ; MD^a ; R. Andrew Taylor ; MD ; MHS^a
• 关键词：AAD ; ascending aortic dissection ; CTA ; computed tomography angiography ; EP FOCUS ; emergency physician focused cardiac ultrasound
• 刊名：The American Journal of Emergency Medicine
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：34
• 期：3
• 页码：486-492
• 全文大小：475 K

文摘

Ascending aortic dissection (AAD) is an uncommon, time-sensitive, and deadly diagnosis with a nonspecific presentation. Ascending aortic dissection is associated with aortic dilation, which can be determined by emergency physician focused cardiac ultrasound (EP FOCUS). We seek to determine if patients who receive EP FOCUS have reduced time to diagnosis for AAD.

c_2">Methods

We performed a retrospective review of patients treated at 1 of 3 affiliated emergency departments, March 1, 2013, to May 1, 2015, diagnosed as having AAD. All autopsies were reviewed for missed cases. Primary outcome measure was time to diagnosis. Secondary outcomes were time to disposition, misdiagnosis rate, and mortality.

c_3">Results

Of 386 547 ED visits, targeted review of 123 medical records and 194 autopsy reports identified 32 patients for inclusion. Sixteen patients received EP FOCUS and 16 did not. Median time to diagnosis in the EP FOCUS group was 80 (interquartile range [IQR], 46-157) minutes vs 226 (IQR, 109-1449) minutes in the non–EP FOCUS group (P = .023). Misdiagnosis was 0% (0/16) in the EP FOCUS group vs 43.8% (7/16) in the non–EP FOCUS group (P = .028). Mortality, adjusted for do-not-resuscitate status, for EP FOCUS vs non–EP FOCUS was 15.4% vs 37.5% (P = .24). Median rooming time to disposition was 134 (IQR, 101-195) minutes for EP FOCUS vs 205 (IQR, 114-342) minutes for non–EP FOCUS (P = .27).

c_4">Conclusions

Patients who receive EP FOCUS are diagnosed faster and misdiagnosed less compared with patients who do not receive EP FOCUS. We recommend assessment of the thoracic aorta be performed routinely during cardiac ultrasound in the emergency department.