Misdiagnosis of ruptured abdominal aortic aneurysm: systematic review and meta-analysis

J Endovasc Ther. 2014 Aug;21(4):568-75. doi: 10.1583/13-4626MR.1.


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.

Keywords: diagnosis; meta-analysis; ruptured abdominal aortic aneurysm; systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Aortic Aneurysm, Abdominal / complications
  • Aortic Aneurysm, Abdominal / diagnosis*
  • Aortic Aneurysm, Abdominal / therapy
  • Aortic Rupture / diagnosis*
  • Aortic Rupture / etiology
  • Aortic Rupture / therapy
  • Diagnosis, Differential
  • Diagnostic Errors*
  • Humans
  • Predictive Value of Tests
  • Prognosis