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Can you accurately rule out acute aortic syndrome by restricting imaging of the aorta to the area of the patient’s pain?

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Abstract

Background

Acute aortic syndrome (AAS) is a life-threatening condition necessitating timely and accurate diagnosis for appropriate treatment. Currently, the only way to rule out the diagnosis is advanced imaging. The most accessible is computed tomography of the entire aorta. Most scans are negative, exposing patients to radiation, increased time in the emergency department (ED), and non-significant incidental findings. This study investigated whether restricting imaging to the area of aortic-related pain accurately rules out AAS.

Methods

A health records review was conducted on consecutive cases from three academic EDs between 2015 and 2020. Data were extracted and verified from multiple sources. Participants included adults diagnosed with AAS based on radiological evidence. The diagnostic performance of the restricted imaging strategy was assessed; sensitivity and likelihood ratios with 95% confidence intervals were calculated.

Results

Data from 149 cases of AAS were collected, with the majority presenting with chest pain (46%) or abdominal pain (24%). The restricted imaging strategy demonstrated a sensitivity of 96% (95% CI 91.4–98.5%) in ruling out AAS. In a subset of patients with systolic blood pressure > 90 mmHg and without aortic aneurysm/repair (n = 86), the sensitivity was 100% (95% CI 96–100%).

Conclusion

Restricting imaging to the area of pain in hemodynamically stable patients without known aortic aneurysm provides a highly sensitive approach to ruling out AAS.

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Author information

Authors and Affiliations

  1. The Department of Emergency Medicine, Health Sciences North, Health Science North Research Institute, Northern Ontario School of Medicine, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5J1, Canada

    Robert Ohle

  2. Department of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Madison Van Dusen

  3. Division of Clinical Sciences, NOSM University, Thunder Bay, ON, Canada

    David W. Savage

  4. Department of Critical Care, Department of Anesthesia, Northern Ontario School of Medicine, Sudbury, ON, Canada

    Sarah McIsaac

  5. Department of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Krishan Yadav

Authors
  1. Robert Ohle
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  2. Madison Van Dusen
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  3. David W. Savage
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  4. Sarah McIsaac
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  5. Krishan Yadav
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Corresponding author

Correspondence to Robert Ohle.

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The authors declare no conflict of interest.

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Clinician Capsule

What is known about the topic?

The only validated way of ruling out an acute aortic syndrome is for a patient to undergo advanced imaging and computed tomography of the entire aorta being the most accessible modality.

What did this study ask?

Can you restrict the location scanned to the area of the aorta relative to the patient’s reported pain and still accurately rule out acute aortic syndrome?

What did this study find?

Restricted imaging in hemodynamically stable patients without known aortic pathology can accurately rule out AAS.

Why does this study matter to clinicians?

Implementing these findings can reduce radiation exposure, imaging time, and incidental findings in those with a clinical suspicion for AAS.

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Ohle, R., Van Dusen, M., Savage, D.W. et al. Can you accurately rule out acute aortic syndrome by restricting imaging of the aorta to the area of the patient’s pain?. Emerg Radiol 30, 719–723 (2023). https://doi.org/10.1007/s10140-023-02179-w

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  • DOI: https://doi.org/10.1007/s10140-023-02179-w

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