Abstract
Introduction
Acute-aortic-dissection (AAD) represents a serious cardiovascular emergency, with an associated mortality of 1-2% per hour after symptom onset. It is known that the relative infrequency of AAD and plausible differentials can negatively impact on a timely diagnosis. Female sex, absence of typical features and high-risk examination findings (hypotension/pulse deficits) shown to delay diagnosis. In UK, services for AAD are centralised, working on established volume/outcome relationships. However, this has the potential to introduce delays in rapidly diagnosing patients without on-site specialist support and in the logistics of transferring patients across large distances. This study aims to report on time taken for patients to receive surgery after first presentation at local hospital and identify points that contribute to maximal delay.
Method
Retrospective analysis of all operated type-A-aortic-dissections at our hospital in 2019. Hospital database used to identify patients, and local/referring hospital documentation reviewed to establish times.
Results
Mean time from A&E presentation to surgery is 8-hours-and-30 minutes (4:16–13:43). Largest contributor to delay is time from A&E admission to CT scan.
Conclusions
Our findings suggest greatest impact on improving times from presentation to surgery is to increase awareness of AAD in regional, non-specialist hospitals and to encourage rapid imaging.