title: Diagnostic performance of emergency transthoracic focus cardiac ultrasound in suspected acute type A aortic dissection.
abstract: Type A aortic dissection (AD) is a deadly disease. Rapid identification of patients requiring immediate advanced aortic imaging or transfer to specialized centers is needed to improve outcomes. We evaluated the diagnostic performance of transthoracic focus cardiac ultrasound (FOCUS) performed by emergency physicians, alone and in combination with the aortic dissection detection (ADD) risk score in suspected type A AD. This was a prospective study performed on patients with suspected type A AD. FOCUS evaluated the presence of intimal flap/intramural hematoma (direct signs of AD), ascending aorta dilatation, aortic valve insufficiency or pericardial effusion/tamponade (indirect signs of AD). The ADD risk score of each patient was calculated according to guidelines. The final diagnosis was established after review of complete clinical data. 50 (18%) patients of 281 had a final diagnosis of type A AD. Detection of any FOCUS sign (direct or indirect) of AD had a sensitivity of 88% (95% CI 76-95%) for the diagnosis of type A AD. Presence of ADD risk score > 0 or detection of any FOCUS sign increased diagnostic sensitivity to 96% (95% CI 86-99%). Detection of direct FOCUS signs had a specificity of 94% (95% CI 90-97%), while combination of ADD risk score > 1 with detection of direct FOCUS signs had a specificity of 98% (95% CI 96-99%). FOCUS demonstrated acceptable accuracy as a triage tool to rapidly identify patients with suspected type A AD needing advanced aortic imaging or transfer, but it cannot be used as a stand-alone test even if combined with ADD risk score classification.
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy, pnazerian@hotmail.com.
authors.forename: Peiman
authors.initials: P
authors.lastname: Nazerian
authors.forename: Simone
authors.initials: S
authors.lastname: Vanni
authors.forename: Matteo
authors.initials: M
authors.lastname: Castelli
authors.forename: Fulvio
authors.initials: F
authors.lastname: Morello
authors.forename: Camilla
authors.initials: C
authors.lastname: Tozzetti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zagli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giannazzo
authors.forename: Ruben
authors.initials: R
authors.lastname: Vergara
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000145:classification / Q000000981:diagnostic imaging*; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000000981:diagnostic imaging*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D014463:Ultrasonography