Emergency physician focused cardiac ultrasound improves diagnosis of ascending aortic dissection

The American Journal of Emergency Medicine
Joseph R PareR Andrew Taylor

Abstract

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. 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. Of 386547 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). Me...Continue Reading

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Citations

Jul 31, 2018·Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine·Rachel B LiuChristopher L Moore
Nov 29, 2017·Circulation·Mohammed A Chamsi-PashaWilliam A Zoghbi
Jan 24, 2020·Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine·Yuan WangZhi Wan
May 10, 2017·Critical Ultrasound Journal·Henrik HedelinJon Karlsson
May 26, 2018·Critical Ultrasound Journal·Joe BetcherRob Huang
Nov 18, 2018·Clinical Practice and Cases in Emergency Medicine·Richard WroblewskiThomas Costantino
May 3, 2020·Internal and Emergency Medicine·Fulvio MorelloPeiman Nazerian
Nov 26, 2019·Clinical Practice and Cases in Emergency Medicine·Matthew FriedmanTina Dulani
Feb 18, 2020·Clinical Practice and Cases in Emergency Medicine·Benjamin BloomThomas G Costantino
Oct 2, 2020·Journal of the American College of Emergency Physicians Open·Woon H ChongScott Beegle
Mar 27, 2018·World Journal of Emergency Medicine·Daniel DeWeertSamir Patel
Nov 1, 2020·The Journal of Emergency Medicine·Alexander W WisbeckMichael C Cooper
Aug 20, 2021·BMJ Quality & Safety·Neha DaveChristine L Paul

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