A Description of the Prehospital Phase of Aortic Dissection in Terms of Early Suspicion and Treatment. Issue 2 (10th February 2015)

• Record Type: Journal Article
• Authors: Axelsson, Christer; Karlsson, Thomas; Pande, Katarina; Wigertz, Kristin; Örtenwall, Per; Nordanstig, Joakim; Herlitz, Johan
• Is Part Of: Prehospital and disaster medicine. Volume 30:Issue 2(2015)
• Page Start: 155
• Page End: 162
• Publication Date: 2015-02-10
• Subjects: aortic dissection, -- Emergency Medical Services, -- prehospital phase; Emergency medical services -- Periodicals; Emergency medicine -- Periodicals; Disaster medicine -- Periodicals; 616.025
• DOI: 10.1017/S1049023X15000060
• Languages: English
• ISSNs: 1049-023X

Abstract

Abstract: Purpose: Aortic dissection is difficult to detect in the early phase due to a variety of symptoms. This report describes the prehospital setting of aortic dissection in terms of symptoms, treatment, and suspicion by the Emergency Medical Service (EMS) staff. Basic Procedures: All patients in the Municipality of Gothenburg, Sweden, who, in 2010 and 2011, had a hospital discharge diagnosis of aortic dissection (international classification of disease (ICD) I 71, 0) were included. The exclusion criteria were: age < 18 years of age and having a planned operation. This was a retrospective, descriptive study based on patient records. In the statistical analyses, Fisher's exact test and the Mann-Whitney U test were used for analyses of dichotomous and continuous/ordered variables. Main findings: Of 92 patients, 78% were transported to the hospital by the EMS. The most common symptom was pain (94%). Pain was intensive or very intensive in 89% of patients, with no significant difference in relation to the use of the EMS. Only 47% of those using the EMS were given pain relief with narcotic analgesics. Only 12% were free from pain on admission to the hospital. A suspicion of aortic dissection was reported by the EMS staff in only 17% of cases. The most common preliminary diagnosis at the dispatch center (31%) and by EMS clinicians (52%) was chest pain or angina pectoris. In all, 79% of patients were discharged alive from the hospital (75% of those that used the EMS and 95% of those that did not). Conclusion: Among patients who were hospitalized due to aortic dissection in Gothenburg, 78% used the EMS. Despite severe pain in the majority of patients, fewer than half received narcotic analgesics, and only 12% were free from pain on admission to the hospital. In fewer than one-in-five patients was a suspicion of aortic dissection reported by the EMS staff. C Axelsson, T Karlsson, K Pande, K Wigertz, P Örtenwall, J Nordanstig, J Herlitz .A description of the prehospital phase of aortic dissection in terms of early suspicion and treatment .Prehosp Disaster Med .2015 ;30 (2 ):1 -8 .