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Variation in CTA evaluation of ED patients suspected of aortic dissection

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Abstract

Purpose

This study was performed to investigate the variation in CTA imaging for AoD in an ED to determine if limiting the scanned region to the chest can effectively rule-out AoD without delaying care.

Methods

A retrospective chart review was performed for all patients belonging to a geographically isolated health maintenance organization who underwent CTA evaluation for possible acute AoD in the emergency department between 2016 and 2020. We evaluated for the regions included in the CTA, the presence of an acute AoD, and clinical outcomes. For those who were ruled-out of an AoD with a CTA limited to the chest, we investigated clinical follow-up up to 6 months after their initial presentation.

Results

Over the study period, there were 1143 CT scans ordered by ED physicians to evaluate for AoD in patients without a history of AoD. Only 23.0% of screening studies were of the chest only. There were 29 acute AoDs diagnosed (14 type A and 15 type B) making for a prevalence of 2.5%. Only one patient with an acute AoD detected on a chest-only CTA required farther imaging, which did not delay clinical care. No patients ruled-out for acute AoD with a chest-only CTA had a return ED visit or repeat CTA within 6 months diagnosing a missed AoD. There were no AoDs limited to the abdominal aorta that would have been missed on a chest-only study.

Conclusion

In patients in the ED with suspected new acute AoD, a CTA limited to the chest can effectively evaluate the condition without delaying care in this integrated healthcare system with 24/7 CT availability.

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Authors and Affiliations

  1. John A. Burns School of Medicine, 651 Ilalo St, Honolulu, HI, 96813, USA

    Jarren K. T. Takaki

  2. Punahou School, 1601 Punahou St, Honolulu, HI, 96822, USA

    Isabella Ford

  3. Department of Radiology, Hawaii Permanente Medical Group, 3288 Moanalua Rd, Honolulu, HI, 96819, USA

    Hyo-Chun Yoon

Authors
  1. Jarren K. T. Takaki
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  2. Isabella Ford
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  3. Hyo-Chun Yoon
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Contributions

Jarren KT Takaki: original study design, data collection, analysis, manuscript preparation, and editing. Isabella Ford: data collection, analysis, manuscript preparation, and editing. Hyo-Chun Yoon: original study design, data collection, analysis, manuscript preparation, and editing.

Corresponding author

Correspondence to Jarren K. T. Takaki.

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The authors declare that they have no conflict of interest.

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Takaki, J.K.T., Ford, I. & Yoon, HC. Variation in CTA evaluation of ED patients suspected of aortic dissection. Emerg Radiol 29, 709–713 (2022). https://doi.org/10.1007/s10140-022-02054-0

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  • DOI: https://doi.org/10.1007/s10140-022-02054-0

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