Aortic dissection in an accident and emergency department in Hong Kong.
OBJECTIVE
To compare the clinical characteristics of aortic dissection in Hong Kong with the International Registry of Aortic Dissection, and to evaluate the sensitivity of the Accident and Emergency Department in diagnosing aortic dissection and its role in aortic dissection management.


METHODS
Retrospective observational study.


METHODS
Regional public hospital, Hong Kong.


METHODS
Newly diagnosed aortic dissection patients attending the Accident and Emergency Department from 2002 to 2005 inclusive.


METHODS
Correct diagnosis in Accident and Emergency Department, tertiary unit transfer, and in-patient mortality.


RESULTS
Twenty-eight patients were found to have aortic dissection, with an estimated annual incidence of 2.1 per 100,000 inhabitants. The sensitivity of Accident and Emergency Department in diagnosing aortic dissection was 54%; 11% of the patients were diagnosed at postmortem examination. Compared to the International Registry of Aortic Dissection, the patients in this Tseung Kwan O Hospital study had less abrupt and less severe pain, less chest pain, and a lower proportion were operated on. Higher mortality was associated with age 70 years or older (odds ratio=6.4), female gender (21.0), known hypertension (3.8), systolic blood pressure below 100 mm Hg (6.0), aortic dissection not diagnosed in the Accident and Emergency Department (3.2), and the patient not reaching tertiary unit (33.8). The hourly cumulative mortality rate was 1.32%. The group of aortic dissections diagnosed in the Accident and Emergency Department had 55.1% more transfer to tertiary unit (95% confidence interval, 14.4-79.1%; P=0.006), 84.5 hours less transfer time (95.3-263.6 hours; P=0.232), and 27.2% lower mortality (12.6-58.6%; P=0.246). The yield rate of contrast computed tomography of thorax was 43%.


CONCLUSIONS
Diagnosing aortic dissection in the Accident and Emergency Department enabled optimal disposition and lower in-patient mortality.
Kung
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SW
Accident and Emergency Department, Tseung Kwan O Hospital, No.2 Po Ning Lane, Hang Hau, Tseung Kwan O, Hong Kong. kungsw@netvigator.com
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D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis* / Q000401:mortality*; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000401:mortality*; D004244:Dizziness / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D013575:Syncope / Q000209:etiology; D013599:Systole; D014839:Vomiting / Q000209:etiology