title: Misdiagnosis of ruptured abdominal aortic aneurysm: systematic review and meta-analysis.
abstract: OBJECTIVE
  To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect differential diagnoses.
  
  
  METHODS
  A systematic search according to PRISMA guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting the initial rate of misdiagnosis of patients with rAAA. Random-effects meta-analyses were performed to estimate the rate of misdiagnosis, presenting features, and commonest differential diagnoses. A sensitivity analysis was performed for studies reporting after 1990.
  
  
  RESULTS
  Nine studies comprising 1109 patients contributed to the pooled analysis, which found a 42% incidence of rAAA misdiagnosis (95% CI 29% to 55%). In studies reporting after 1990, misdiagnosis was seen in 32% (95% CI 16% to 49%). The most common erroneous differential diagnoses were ureteric colic and myocardial infarction. Abdominal pain, shock, and a pulsatile mass were presenting features in 61% (49%-72%), 46% (32%-61%), and 45% (29%-62%) of rAAAs, respectively.
  
  
  CONCLUSIONS
  The rate of misdiagnosis of rAAA has remained consistent over time and is concerning. There is a need for an effective clinical decision tool to enable accurate diagnosis and triage at the scene of the emergency.
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK.
authors.forename: Bilal
authors.initials: B
authors.lastname: Azhar
authors.forename: Shaneel R
authors.initials: SR
authors.lastname: Patel
authors.forename: Peter J E
authors.initials: PJ
authors.lastname: Holt
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: Matt M
authors.initials: MM
authors.lastname: Thompson
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D001019:Aortic Rupture / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis
keywords: diagnosis; meta-analysis; ruptured abdominal aortic aneurysm; systematic review