The frequency of initial misdiagnosis of acute aortic dissection in the emergency department and its impact on outcome.

Abstract

We determine the frequency of initial misdiagnosis and inappropriate treatment with antiplatelets/anticoagulants in the emergency department (ED) and the resultant clinical outcomes in patients with acute type A aortic dissection (AAOD). Medical records of patients with a final diagnosis of AAOD admitted from March 2004 through October 2015 to our tertiary-level heart hospital were evaluated. Patients with suspected dissection in ED were compared to those with initial misdiagnosis regarding demographics and clinical presentation, laboratory and echocardiographic findings. Our primary outcome was hospital mortality in two groups. Long-term mortality after discharge was our secondary outcome. Among 189 patients, 47 (24.8%) were initially misdiagnosed and received antiplatelets/anticoagulants in ED (Group F), and 142 (75.1%) were appropriately diagnosed in ED (Group T). The mean age in group F was 60.4±15.0 vs. 57.4±16.0years in group T (p=0.260). In group F, 70.2% were male vs. 60.6% in group T (p=0.311). Hospital mortality was 48.9% in group F vs. 43.7% in group T (p=0.645). Long-term mortality was significantly higher in group F (55.6 vs. 21.2%, p=0.007). Univariate hazard ratio (HR) of initial misdiagnosis for long-term mortality was 2.56 (95% CI 1.08-6.06, p=0.031). In multivariate Cox regression analysis with adjustment for age and type of management (surgical/medical), initial misdiagnosis lost its significance for predicting long-term mortality (HR 2.14, 95% CI 0.89-5.13, p=0.086). Initial misdiagnosis of AAOD is a common problem. Hospital mortality is not significantly affected by receiving antiplatelets/anticoagulants. Although long-term mortality is higher in patients with initial misdiagnosis, it is not an independent predictor for long-term mortality.