Aims, Objectives and Background Acute aortic pathologies have a high mortality rate and can be difficult to diagnose in the Emergency Department (ED). We wanted to know what our local positive diagnosis rate was from ED-requested CT aortograms (CTA).
Method and Design The radiology department provided a list of all CTA requested by ED during 2019. A retrospective notes review was conducted using the ED notes to identify diagnoses of acute aortic pathology and other positive diagnoses. Our ED saw approximately 90,000 adult patients in 2019.
Results and Conclusion 201 CTA were requested by ED in a single year (2019).
5 (2.4%) scans diagnosed acute aortic syndrome (AAS), with an additional 3 scans that identified thoracic aortic aneurysm without AAS.
13 (6.5%) abdominal aortic aneurysms were identified of which 2 had ruptured.
In addition, 24 (11.9%) patients had non aortic pathologies identified from the scan (6 gallstones, 3 pneumonia, 3 renal colic, 2 metastatic disease, 2 pancreatitis, 2 pulmonary embolism, 6 ‘other’ diagnoses).
Of those with confirmed AAS, only one had an ADD-RS (aortic dissection detection risk score) of 2 (>2 recommend straight to CTA), four had a score of 0 or 1 and none had a D-dimer recorded.
It is sometimes perceived that CTA has a low diagnostic yield, but 23% of patients scanned in our cohort were able to have a positive diagnosis made after their scan, with approximately half of identified pathology being non-aortic.
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