Abstract 17392: Bilateral Blood Pressure Measurement: a Simple Way to Reduce Diagnostic Delay in Acute Type a Aortic Dissection
Introduction: Despite rapid presentation, the majority of patients with acute type A aortic dissection (ATAAD) have significant delays to diagnosis and surgical treatment.
Hypothesis: We set out to investigate factors associated with diagnostic delay in ATAAD in the UK.
Methods: As part of a UK-wide national audit, patients admitted to their institution with a known diagnosis of ATAAD between January 2009 and July 2011 were identified. Using a standardised questionnaire, retrospective data was collected on presentational symptoms, time, potential differential diagnoses, time to operative intervention and outcomes.
Results: A total of 14 centres submitted data on a total of 239 patients. At presentation 91.6% were symptomatic and the majority (74.5%) presented to non-surgical centres. Bilateral upper limb blood pressures were recorded in 48.4% and of these 56.3% had a >20mmHg difference in blood pressure. The median [IQR] time between symptom onset and admission was 2 hours (h) [1.2-4.9], between admission and diagnosis 4.5 [2.3-18.3] h and between symptoms to operation was 14.8 [9.1-32.8] h. Diagnosis delay was greater than 3 h in 63% of patients and than 12 h in 33%. Surgical in-hospital mortality was 22.5%. In only 155 (64.9%) patients ATAAD was included in the differential diagnosis at initial presentation. Non-consideration of ATAAD was significantly higher in patients presenting without pain (52% vs. 29%, p: 0.039) and in whom only unilateral BP measurement was taken (43% vs. 13%, p <0.0001) and significantly lower in whom a 20 mmHg difference in BP between arms was found (26% vs. 6%, p <0.013). Measurement of unilateral BP was significantly associated with a delay in diagnosis of greater than 3 h (72% vs. 52%, p: 0.043) and greater than 12 h (47% vs. 14%, p<0.0001). Non-consideration of ATAAD resulted in administration of heparin and/or antiplatelets in 21% of patients.
Conclusions: There are still significant delays in diagnosis and management of ATAAD. These are in part related to non-consideration of the potential diagnosis. Measurement of bilateral BP is a simple intervention and may reduce non-consideration of the diagnosis by revealing patients with a pulse deficit and increasing the index of suspicion to aid in the diagnosis of ATAAD.
Author Disclosures: M. Iafrancesco: None. J. Mascaro: None. M. Abdelaziz: None. S. Bhudia: None. I.A. Rahman: None. A.J. Bryan: None. A.P. Modi: None. G. Tsang: None. F. Pirone: None. M.E. Lewis: None. G. Doukas: None. A.J. Ritchie: None. A.K. Bose: None. J.H. Dark: None. E.W. Peng: None. A. Goodwin: None. K. Bhakhri: None. N. Roberts: None. H. Siddiqui: None. O. Wendler: None. M. Loubani: None. M. Bashir: None. D. Harrington: None. A.Y. Oo: None. R. Ibe: None. A. Chukwuemeka: None. A.M. Ranasinghe: None.
- © 2014 by American Heart Association, Inc.