Ruptured abdominal aortic aneurysm: initial misdiagnosis and the effect on treatment.
OBJECTIVE
To evaluate the incidence of misdiagnosis in ruptured abdominal aortic aneurysm and its effect on treatment and outcome.


METHODS
Retrospective study.


METHODS
Teaching hospital, The Netherlands.


METHODS
97 consecutive patients admitted with ruptured abdominal aortic aneurysm during the 5-year period, 1 January 1989--31 December 1993.


METHODS
Initial diagnosis, interval between onset of symptoms and admission, and mortality.


RESULTS
38 Patients (43%) presented with symptoms of their aneurysm exceeding nine hours prior to admission (range 10 hours to 14 days, median 2 days). Fifty patients (60%) were initially misdiagnosed by the referring practitioner. Ultrasonography was consistent with rupture in only 36/70 (51%). 52 Patients died (54%), (operative mortality 45 (46%)), and was not affected by delay in diagnosis or treatment.


CONCLUSIONS
Although delay in diagnosis or treatment did not seem to affect mortality, improved awareness of non-specific presentations of (imminent) rupture will result in fewer misdiagnoses and earlier treatment. A group of patients will undoubtedly benefit from this as they can be operated on at a stage when expected mortality is lower.
Akkersdijk
G J
GJ
Department of Vascular Surgery, University Hospital Leiden, The Netherlands.
van Bockel
J H
JH
D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D003951:Diagnostic Errors; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged