title: A description of the prehospital phase of aortic dissection in terms of early suspicion and treatment.
abstract: OBJECTIVE
  Aortic dissection is difficult to detect in the early phase due to a variety of symptoms. This report describes the prehospital setting of aortic dissection in terms of symptoms, treatment, and suspicion by the Emergency Medical Service (EMS) staff.
  
  
  METHODS
  All patients in the Municipality of Gothenburg, Sweden, who, in 2010 and 2011, had a hospital discharge diagnosis of aortic dissection (international classification of disease (ICD) I 71,0) were included. The exclusion criteria were: age<18 years of age and having a planned operation. This was a retrospective, descriptive study based on patient records. In the statistical analyses, Fisher's exact test and the Mann-Whitney U test were used for analyses of dichotomous and continuous/ordered variables.
  
  
  RESULTS
  Of 92 patients, 78% were transported to the hospital by the EMS. The most common symptom was pain (94%). Pain was intensive or very intensive in 89% of patients, with no significant difference in relation to the use of the EMS. Only 47% of those using the EMS were given pain relief with narcotic analgesics. Only 12% were free from pain on admission to the hospital. A suspicion of aortic dissection was reported by the EMS staff in only 17% of cases. The most common preliminary diagnosis at the dispatch center (31%) and by EMS clinicians (52%) was chest pain or angina pectoris. In all, 79% of patients were discharged alive from the hospital (75% of those that used the EMS and 95% of those that did not).
  
  
  CONCLUSIONS
  Among patients who were hospitalized due to aortic dissection in Gothenburg, 78% used the EMS. Despite severe pain in the majority of patients, fewer than half received narcotic analgesics, and only 12% were free from pain on admission to the hospital. In fewer than one-in-five patients was a suspicion of aortic dissection reported by the EMS staff.
authors: 1University of Borås,School of Health Science,Borås,Sweden.
authors: Christer
authors: C
authors: Axelsson
authors: 2Institute of Internal Medicine,Department of Metabolism and Cardiovascular Research,Sahlgrenska University Hospital,Gothenburg,Sweden.
authors: Thomas
authors: T
authors: Karlsson
authors: 3Department of Cardiology,Sahlgrenska University Hospital,Östra,Gothenburg,Sweden.
authors: Katarina
authors: K
authors: Pande
authors: 3Department of Cardiology,Sahlgrenska University Hospital,Östra,Gothenburg,Sweden.
authors: Kristin
authors: K
authors: Wigertz
authors: 4Armed Forces Centre for Defence Medicine,Gothenburg,Sweden.
authors: Per
authors: P
authors: Örtenwall
authors: 5Department of Vascular Surgery,Sahlgrenska University Hospital,Gothenburg,Sweden.
authors: Joakim
authors: J
authors: Nordanstig
authors: 2Institute of Internal Medicine,Department of Metabolism and Cardiovascular Research,Sahlgrenska University Hospital,Gothenburg,Sweden.
authors: Johan
authors: J
authors: Herlitz
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis* / Q000401:mortality; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000401:mortality; D003937:Diagnosis, Differential; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D010147:Pain Measurement; D011379:Prognosis; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology
chemical_list: D009294:Narcotics
keywords: ECG electro cardiogram; ED emergency department; EMS Emergency Medical Services; ICD international classification of diseases; VAS visual analogue scale; prehospital phase