RT Journal Article
SR Electronic
T1 The risk of misdiagnosis in acute thoracic aortic dissection: a review of current guidelines
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 885
OP 891
DO 10.1136/heartjnl-2019-316322
VO 106
IS 12
A1 M Yousuf Salmasi
A1 Nina Al-Saadi
A1 Philip Hartley
A1 Omar A Jarral
A1 Shahzad Raja
A1 Muthana Hussein
A1 Julian Redhead
A1 Ulrich Rosendahl
A1 Christoph A Nienaber
A1 John R Pepper
A1 Aung Y Oo
A1 Thanos Athanasiou
YR 2020
UL http://heart.bmj.com/content/106/12/885.abstract
AB Acute aortic syndrome and in particular aortic dissection (AAD) persists as a cause of significant morbidity and mortality despite improvements in surgical management. This clinical review aims to explore the risks of misdiagnosis, outcomes associated with misdiagnosis and evaluate current diagnostic methods for reducing its incidence.Due to the nature of the pathology, misdiagnosing the condition and delaying management can dramatically worsen patient outcomes. Several diagnostic challenges exist, including low prevalence, rapidly propagating pathology, non-discrete symptomatology, non-specific signs, analogy with other acute conditions and lack of management infrastructure. A similarity to acute coronary syndromes is a specific concern and risks patient maltreatment. AAD with malperfusion syndromes are both a cause of misdiagnosis and marker of disease complication, requiring specifically tailored management plans from the emergency setting.Despite improvements in diagnostic measures, including imaging modalities and biomarkers, misdiagnosis of AAD remains commonplace and current guidelines are relatively limited in preventing its occurrence. This paper recommends the early use of AAD risk scoring, focused echocardiography and most importantly, fast-tracking patients to cross-sectional imaging where the suspicion of AAD is high. This has the potential to improve the diagnostic process for AAD and limit the risk of misdiagnosis. However, our understanding remains limited by the lack of large patient datasets and an adequately audited processes of emergency department practice.