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Finding the needle in the haystack: towards better diagnosis of acute aortic syndromes
  1. Peter Jones
  1. Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to A/Prof Peter Jones, Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand; PeterJ{at}adhb.govt.nz

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McLatchie and colleagues present observational data on the prevalence of acute aortic syndromes (AAS) in 27 emergency departments (ED) in the UK, over 2–55 days.1 They found that the prevalence of AAS was around 1 in 300 patients presenting to ED with chest, back or abdominal pain; or ‘malperfusion’ (defined as stroke, myocardial infarction, bowel or limb ischaemia), while the CT aortogram rate was 7%. In a separate study, the same group of authors present national survey data showing inconsistency in the approach to diagnosing AAS in EDs across the UK.2

The observational study is important, as the authors attempted to identify AAS cases prospectively from an undifferentiated patient cohort. Despite being the most relevant to clinical practice in the ED, this methodology is rarely used in diagnostic accuracy studies due to logistic and cost issues. Prospective identification of cases from an undifferentiated cohort enables a more reliable estimate of the accuracy of our diagnostic armamentarium than retrospective case identification, especially when only selected patients are included in the latter (such as those going for CT or having a D-Dimer test). That fewer than half of patients were prospectively identified despite a highly engaged stakeholder group undertaking the present study speaks volumes to the need for dedicated research staff embedded within ED, rather than hoping that busy clinical …

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Footnotes

  • Handling editor Alex Novak

  • Correction notice Since this content first published, the DOI of reference 2 has been updated.

  • Contributors PJ was the sole author of this commentary on two studies around the diagnosis of Acute Aortic Syndromes in the ED.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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