title: Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study.
abstract: OBJECTIVE
  The aim of this study was to describe the presentation of patients with ruptured abdominal aortic aneurysm (rAAA) and identify factors contributing toward misdiagnosis.
  
  
  METHODS
  This was an observational study of cases with a final diagnosis of rAAA assessed at nine Emergency Departments and managed at one of two regional vascular centres in the UK.
  
  
  RESULTS
  Eighty-five consecutive cases were included. Seventeen [20.0%, 95% confidence interval (CI) 11.5-28.5%] patients reported important symptoms up to 3 weeks before index presentation. In the Emergency Department, most patients complained of abdominal and/or back pain, seven (8.2%, 95% CI 2.4-14.0%) additionally reported atypical pain and ten (11.8%, 95% CI 4.9-18.7%) denied pain altogether. Hypotension (36.5%, 95% CI 26.3-46.7%), tachycardia (18.8%, 95% CI 10.5-27.1%) and syncope (36.5%, 95% CI 26.3-46.7%) were documented in a minority of cases. Distracting symptoms were present in 33 (38.8%, 95% CI 28.4-49.2%) patients. The median time to diagnosis was 17.5 min (range immediate-12 days), and 21 (25.6%, 95% CI 16.3-34.9%) patients were misdiagnosed during clinical assessment.
  
  
  CONCLUSIONS
  The classical signs and symptoms or rAAA are not always present and patients frequently show additional features that may confound the diagnosis. A high level of suspicion should be adopted for rAAA alongside a low threshold for immediate computed tomography. Further research is required to develop an objective clinical risk score or predictive tool for characterizing patients at risk.
authors.affiliation: St George's Vascular Institute, 4th Floor St James' Wing, St George's Hospital, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Metcalfe
authors.forename: Kapil
authors.initials: K
authors.lastname: Sugand
authors.forename: Sri G
authors.initials: SG
authors.lastname: Thrumurthy
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Thompson
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Holt
authors.forename: Alan Prasanna
authors.initials: AP
authors.lastname: Karthikesalingam
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis*; D001019:Aortic Rupture / Q000150:complications / Q000175:diagnosis*; D001416:Back Pain / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D013575:Syncope / Q000209:etiology; D013610:Tachycardia / Q000209:etiology; D013997:Time Factors; D006113:United Kingdom