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J Korean Soc Emerg Med > Volume 23(6); 2012 > Article
Journal of The Korean Society of Emergency Medicine 2012;23(6): 784-790.
Diagnosis of Acute Aortic Dissection by the 2010 American Heart Association Guideline at Emergency Room: Analysis of a Delayed Diagnosis
Woong Park, Chul Hyun Park, Yang Bin Jeon, Jae Ik Lee, Chang Hu Choi, Kook Yang Park, Jin Joo Kim, Sung Youl Hyun, Hyuk Jun Yang, Eun Young Kim
1Department of Cardiothoracic and Vascular Surgery, Gil Hospital, Gachon University, Incheon, Korea. cdgpch@gilhospital.com
2Department of Emergency Medicine, Gil Hospital, Gachon University, Incheon, Korea.
3Department of Radiology, Gil Hospital, Gachon University, Incheon, Korea.
Acute aortic dissection is a rare and life-threatening disease, requiring an immediate evaluation and treatment. In 2010, the American College of Cardiology/American Heart Association suggested a new risk score system for the detection of an acute aortic dissection. This system was applied to our known patients with acute aortic dissection.
155 patients with acute aortic dissection regardless of the types from January 2000 to June 2012 were examined. The known risk factors and 12 newly proposed risk factors were compared, based on the new guidelines, after dividing them into a delayed diagnosis group and early diagnosis group. The impact of the aortic dissection detection (ADD) risk score on the diagnostic process was assessed.
The abrupt onset of pain was the most frequent symptom (65.2%) and only had an impact on an early diagnosis (p=0.021). 83 patients (53.5%) showed a widened mediastinum in the chest X-rays. The diagnosis was delayed in 21 patients (13.8%). According to the new guideline, 149(96.1%) were identified by 1 or more of the 12 clinical markers. 6(3.8%), 88(56.8%) and 61(39.3%) patients were classified as low, intermediate and high risk, respectively. Three of the 6 low risk patients showed mediastinal widening.
The clinical risk markers and the ADD risk score system in the 2010 guidelines detected patients with high sensitivity. The new risk score system appears to be a valuable diagnostic index at the initial presentation.
Key words: Aortic dissection, Guideline, Delayed diagnosis
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