title: When to activate a multidisciplinary team for an acute abdominal aortic aneurysm?
abstract: BACKGROUND
  It is often difficult to determine when a multidisciplinary aneurysm team should be summoned based on the (often limited) pre-hospital information provided
  
  
  METHODS
  We performed a retrospective cohort study of patients brought to our hospital between January 1st 2013 and October 1st 2014 by the emergency medical services (EMS) with a clinical suspicion of an acute AAA. Within this group we compared patients with a documented acute AAA and without an acute AAA in order to identify patient characteristics that could be used for the development of evidence based activation criteria for multidisciplinary acute aneurysm teams.
  
  
  RESULTS
  Of the 63 patients presented by the EMS with a clinical suspicion of an acute AAA, 16 had an acute AAA. The optimal age cut-off value to discriminate patients with- from patients without an acute AAA was 70 years, whereas the optimal cut-off systolic blood pressure was 137 mmHg. "Age> 70" (LR+ 2.6 [1.8-3.8], "SBP <137mm Hg" (LR+ 2.6 [1.5-4.9], the "presence of diaphoresis " (LR+ 2.5 [1.7-3.8] and a "prior history of AAA" (LR+ 2.9 [1.5-5.7] were independent predictors of the presence of an acute AAA. The presence of any of these factors increased the pre-test probability of an acute AAA to > 50%.
  
  
  CONCLUSIONS
  Pre-hospital information regarding the patient's age, history (known AAA), blood pressure and general appearance (presence of diaphoresis) can be useful when EMS services announce the arrival of a patient with suspected acute AAA in order to improve appropriate triage and minimize time to definitive care.
authors.affiliation: Department of Emergency Medicine, Medical Centre Leeuwarden, Henry Dunantweg 2, 8934 AD Leeuwarden, the Netherlands. Electronic address: Martha.Maltha@ZNB.nl.
authors.forename: M
authors.initials: M
authors.lastname: Maltha
authors.affiliation: Department of Emergency Medicine, Medical Centre Leeuwarden, Henry Dunantweg 2, 8934 AD Leeuwarden, the Netherlands. Electronic address: Anniek.Visser2@ZNB.nl.
authors.forename: A
authors.initials: A
authors.lastname: Visser
authors.affiliation: Medical manager EMS service RAV Fryslân, Ottolaan 2, 9207 JR Drachten, the Netherlands. Electronic address: T.Sandjer@Treant.nl.
authors.forename: T
authors.initials: T
authors.lastname: Sandjer
authors.affiliation: Department of Vascular Surgery, Medical Centre Leeuwarden, Henry Dunantweg 2, 8934 AD Leeuwarden, the Netherlands. Electronic address: A.K.Jahrome@znb.nl.
authors.forename: A K
authors.initials: AK
authors.lastname: Jahrome
authors.affiliation: Department of Radiology, Medical Centre Leeuwarden, Henry Dunantweg 2, 8934 AD Leeuwarden, the Netherlands. Electronic address: Ted.Vink@znb.nl.
authors.forename: T W F
authors.initials: TW
authors.lastname: Vink
authors.affiliation: Department of Emergency Medicine, Medical Centre Leeuwarden, Henry Dunantweg 2, 8934 AD Leeuwarden, the Netherlands. Electronic address: Ewoud.ter.Avest@znb.nl.
authors.forename: E
authors.initials: E
authors.lastname: Ter Avest
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D012189:Retrospective Studies; D014218:Triage / Q000458:organization & administration*