title: Emergency department led emergency ultrasound may improve the time to diagnosis in patients presenting with a ruptured abdominal aortic aneurysm.
abstract: OBJECTIVE
  Does emergency ultrasound (EU) improve the speed of diagnosis of patients presenting to the emergency department (ED) with a ruptured abdominal aortic aneurysm (rAAA)?
  
  
  METHODS
  This is a retrospective study of all patients presenting to the ED of the Royal Infirmary of Edinburgh (RIE) with an rAAA. The RIE surgical database and the RIE ED registry of emergency-based ultrasound scans were assessed and time to diagnose rAAA was compared for the periods before and after the introduction of EU, as well as for rAAA patients who underwent EU and those who did not. Patients with known AAA and those transferred from another hospital with known or suspected rAAA were excluded.
  
  
  RESULTS
  Between 27 December 2006 and 13 January 2009, before the establishment of our EU programme, 65 patients presented to the ED of RIE with an rAAA. The median time to diagnosis was 95 min [interquartile range (IQR) 41-195 min; n=30]. Between 14 January 2009 and 15 February 2012, after the establishment of our EU programme, 54 patients presented to the ED of RIE with an rAAA. The median time to diagnosis was 64 min (IQR 31-140 min; n=28; Z=0.95, P=0.3421). Eighteen out of the 28 patients with rAAA underwent EU; the median time to diagnosis was 60 min (IQR 27-115 min; n=18). Of the patients with rAAA, 35 did not undergo EU; the median time to diagnosis was 111 min (IQR 45-213 min; n=35; Z=-1.69, P=0.091). There was no improvement in survival between patients who underwent an ED EU and those who did not (P=0.40).
  
  
  CONCLUSIONS
  There was a nonsignificant trend towards a faster time to diagnosis (51 min) in rAAA patients who underwent EU on presenting to the ED compared with those who did not undergo an ED EU (111 min). There was no improvement in survival or length of ICU unit stay.
authors.affiliation: aCollege of Medicine and Veterinary Medicine, University of Edinburgh bEmergency Medicine Research Group Edinburgh (EMeRGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Reed
authors.forename: Lai-Ting
authors.initials: LT
authors.lastname: Cheung
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality; D001019:Aortic Rupture / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography