Misdiagnosis of Ruptured Abdominal Aortic Aneurysm: Systematic Review and Meta-Analysis. (August 2014)

• Record Type: Journal Article
• Authors: Azhar, Bilal; Patel, Shaneel R.; Holt, Peter J.E.; Hinchliffe, Robert J.; Thompson, Matt M.; Karthikesalingam, Alan
• Is Part Of: Journal of endovascular therapy. Volume 21:Number 4(2014)
• Page Start: 568
• Page End: 575
• Publication Date: 2014-08
• Subjects: ruptured abdominal aortic aneurysm -- diagnosis -- systematic review -- meta-analysis; Blood-vessels -- Endoscopic surgery -- Periodicals; Angioscopy -- Periodicals; Intravenous catheterization -- Periodicals; Peripheral vascular diseases -- Treatment -- Periodicals; Vascular Surgical Procedures -- Periodicals; Angioscopy -- Periodicals; Catheterization, Peripheral -- Periodicals; Peripheral Vascular Diseases -- therapy -- Periodicals; Angioscopie; Maladies vasculaires périphériques; 617.413
• DOI: 10.1583/13-4626MR.1
• Languages: English
• ISSNs: 1526-6028

Abstract

Purpose: To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect differential diagnoses. Methods: A systematic search according to PRISMA guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting the initial rate of misdiagnosis of patients with rAAA. Random-effects meta-analyses were performed to estimate the rate of misdiagnosis, presenting features, and commonest differential diagnoses. A sensitivity analysis was performed for studies reporting after 1990. Results: Nine studies comprising 1109 patients contributed to the pooled analysis, which found a 42% incidence of rAAA misdiagnosis (95% CI 29% to 55%). In studies reporting after 1990, misdiagnosis was seen in 32% (95% CI 16% to 49%). The most common erroneous differential diagnoses were ureteric colic and myocardial infarction. Abdominal pain, shock, and a pulsatile mass were presenting features in 61% (49%–72%), 46% (32%–61%), and 45% (29%–62%) of rAAAs, respectively. Conclusion: The rate of misdiagnosis of rAAA has remained consistent over time and is concerning. There is a need for an effective clinical decision tool to enable accurate diagnosis and triage at the scene of the emergency.