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Misdiagnosis of ruptured abdominal aortic aneurysms is common and is associated with increased mortality
- Source :
- Journal of vascular surgery. 73(2)
- Publication Year :
- 2019
-
Abstract
- Objective To investigate the rate of misdiagnosis in the emergency department in patients with ruptured abdominal aortic aneurysms (rAAAs), and to investigate how misdiagnosis affects rAAA mortality. Methods Data were extracted from the Swedish Cause of Death Registry and the Swedish National Registry for Vascular Surgery from 2010 to 2015. All rAAA patients registered in the health care system in the west of Sweden were identified. Medical charts for rAAA patients were reviewed, and patients who were correctly diagnosed at the first assessment in the emergency department were compared with patients who were misdiagnosed. Results Altogether, 455 patients with rAAA were identified, including both patients who underwent surgery and those who did not. One hundred seventy-seven (38.9%) were initially misdiagnosed. The mortality rate was 74.6% in patients who were misdiagnosed, as compared with 62.9% in correctly diagnosed patients (P = .01). The adjusted odds ratio for mortality in misdiagnosed patients relative to correctly diagnosed patients was 1.83 (95% confidence interval, 1.13-2.96) (P = .01). When excluding patients offered palliative care (n = 134) after detection of the rAAA, the mortality in initially misdiagnosed patients was 65.1% as compared with 46.4% in correctly diagnosed patients (P = .001). In patients reaching surgical intervention, 37 (45.1%) of the primarily misdiagnosed patients died (30-day or in-hospital mortality) as compared with 63 (38.0%) of the correctly diagnosed (P = .34). Conclusions Misdiagnosis is common in patients with rAAA, and it is associated with a substantially higher risk of dying from the ruptured aneurysm.
- Subjects :
- Male
medicine.medical_specialty
Palliative care
Time Factors
Aortic Rupture
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Aneurysm
Predictive Value of Tests
Risk Factors
Medicine
Humans
030212 general & internal medicine
Hospital Mortality
Registries
Diagnostic Errors
Cause of death
Aged
Retrospective Studies
Aged, 80 and over
Sweden
business.industry
Mortality rate
Odds ratio
Emergency department
Vascular surgery
medicine.disease
Prognosis
Abdominal aortic aneurysm
Surgery
Female
Cardiology and Cardiovascular Medicine
business
Aortic Aneurysm, Abdominal
Subjects
Details
- ISSN :
- 10976809
- Volume :
- 73
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Journal of vascular surgery
- Accession number :
- edsair.doi.dedup.....1f73ba48fde837eac7ab4ef299c959c8