A 12-year Retrospective Cohort Study of Point-of-care Ultrasound and Aortic Dissection Risk Score in Type A Aortic Dissection

Abstract

BackgroundAortic dissection (AD) is a vascular emergency with time-dependent mortality. Point-of-care ultrasound (POCUS) and aortic dissection risk score (ADRS) have been proposed as diagnostic tools to risk stratify patients and reduce time to diagnosis. ObjectiveWe evaluate POCUS findings and ADRS in a retrospective cohort of patients with known type A AD. The objective of this study is to describe the prevalence of POCUS findings and ADRS in this population. MethodsThis is a retrospective cohort study of patients with acute type A AD as confirmed on CT scan over a 12-year period from 2008-2020, with a subgroup analysis of patients who received POCUS in the emergency department. ADRS was calculated and POCUS findings were reviewed. Descriptive statistics were used to describe the distribution of POCUS findings. Results91 patients met inclusion criteria. POCUS was performed in 41 but only 35 had images of adequate quality for inclusion. Of the POCUS images available, 30/35 (86%) patients had a POCUS finding consistent with dissection and 5/35 (14%) had no findings on POCUS. 12% (11/91) of patients had ADRS=0. Two patients with ADRS=0 received POCUS, and 1 patient had no findings on POCUS. ConclusionAlthough POCUS provides rapid information in the diagnosis of type A AD, 14% of patients with images available for review had no findings on POCUS. Of the whole cohort, 12% had an ADRS=0. Further studies are needed to identify an optimal diagnostic pathway for this catastrophic disease.