351 The Diagnosis of Carotid and Vertebral Artery Dissections by Emergency Physicians is Rare

Abstract

Carotid and vertebral artery dissections are rare events. The most frequent symptoms are head and neck pain and neurological deficits, but these are common emergency department (ED) chief complaints and other diseases causing these occur much more often. Furthermore, about one-third of patients have no headache, one-third have no neck pain and over 10% have no neurologic deficits. For these reasons, diagnosing dissections is challenging. We wished to quantify the magnitude of this problem in a large ED database. Our goal was to determine the number of total ED visits for every carotid and vertebral artery dissection diagnosed by ED physicians. Design: Multicenter retrospective cohort. Setting: 27 suburban and urban New York and New Jersey EDs with annual visits between 20,000 and 119,000. Participants: Patients seen by ED physicians in the four-year period from 11-1-2015 through 10-31-2019. Observations: We identified carotid and vertebral artery dissections using ICD-10 codes. We then calculated the number of ED visits for every carotid and vertebral artery dissection, along with 95% confidence intervals (CIs). From a database of 6,223,499 ED visits, we identified 115 carotid artery dissections and 97 vertebral artery dissections. The median ages (with interquartile ranges) and percent female of carotid and vertebral artery dissection patients were 54 years (41, 64), 47 years (38, 63), 55% and 51%, respectively. Of the total ED visits there was one carotid artery dissection for every 54,117 (95% CI 45,089 to 64,953) visits and one vertebral artery dissection for every 64,160 (95% CI 52,599 to 78,261) visits. The diagnosis of carotid and vertebral artery dissections by ED physicians is rare. An ED physician seeing 3,000-4000 patients a year would diagnose one carotid artery dissection every 13 to18 years and one vertebral artery dissection every 16 to 21 years.Tabled 1Row LabelsCount of Billed ICD DescriptionNumber of visits for each diagnosisDissection of carotid artery11554117.38Dissection of renal artery23111750Dissection of vertebral artery9764159.78Extradural and subdural abscess, unspecified7286437.49Intraspinal abscess and granuloma12649392.85total visits622349927 hospitals Open table in a new tab