Research forum abstract
364 Point-of-Care Ultrasound for the Detection of Aortic Dissections in the Emergency Department

https://doi.org/10.1016/j.annemergmed.2017.07.334Get rights and content

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Study Objectives

Aortic dissections are uncommon but potentially life-threatening emergencies requiring a high index of clinical suspicion for emergency medicine providers. The most reliable diagnostic test for an acute aortic dissection is CT angiography, although this test cannot be performed at the bedside. Transthoracic echocardiography (TTE) has yielded a lower sensitivity, mainly due to its inability to diagnose Type B dissections while being nearly 100% sensitive for Type A dissections using dilation of

Methods

Single center, retrospective review of all patients evaluated in the ED after our protocol had been established from January 1, 2010 through March 31, 2017 who had a diagnosis of aortic dissection confirmed by CT angiography. According to our protocol, we used 3 signs from TTE to suggest AD: the presence of either a pericardial effusion or intimal flap, or an aortic outflow track size of greater than 3.5 cm during diastole (measured from inner wall to inner wall within 2cm of the aortic

Results

442 ultrasounds were performed for suspected AD. 28 patients were identified during the study period. 12 had a Stanford type A dissection. 16 had a Stanford type B. 27 of the 28 patients had at least one of the aforementioned findings. The only patient not diagnosed with bedside ultrasound had a Stanford type B dissection limited to the descending thoracic aorta. The most common positive finding was an intimal flap, identified in 23 out of 28 patients, including 15 type B patients. These

Conclusions

By combining TTE with abdominal aortic ultrasound in patients with suspected aortic dissection, we were able to diagnose 96.4% of patients who presented to our institution with an aortic dissection (100% of type A dissections). Furthermore, the presence of an intimal flap was also 100% specific for aortic dissection. Future prospective studies can further evaluate test characteristics of this combined ultrasound protocol.

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