Early Screening for Aortic Dissection With Point-of-Care Ultrasound by Emergency Physicians: A Prospective Pilot Study

J Ultrasound Med. 2020 Jul;39(7):1309-1315. doi: 10.1002/jum.15223. Epub 2020 Jan 23.

Abstract

Objectives: To investigate the effect of point-of-care ultrasound (POCUS) use by emergency physician (EPs) on the diagnosis, treatment, and safety of POCUS in patients with aortic dissection (AD) in emergency settings.

Methods: Patients presenting to the emergency department of West China Hospital of Sichuan University with suspected AD from July 1, 2016, to December 31, 2016 were divided into a control group and an ultrasound (US) group. The control group was evaluated by routine procedures for triage, diagnosis, and treatment. In addition, an EP POCUS examination was performed in the US group. The patients in the US group were furtherly divided into subgroup A and subgroup B according to the Stanford type of AD. The sensitivity and specificity of EP POCUS compared to computed tomographic angiography (CTA) were compared. The door-to-CTA examination time, door-to-diagnosis time, door-to-targeted treatment time, and outcome were compared between the groups.

Results: A total of 127 patients were enrolled: 72 in the US group and 55 in the control group. In the US group, compared with CTA, the sensitivity of EP POCUS was 86.4%, and the specificity was 100.0%. The door-to-diagnosis times were 10.5 minutes in the US group and 79.0 minutes in the control group (P < .05). The door-to-CTA examination time and the door-to-targeted-treatment time had no differences between the US and control groups (P > .05). The in-hospital mortality and mortality within 3 months after discharge were 4.2% and 25.0% in the US group and 9.1% and 20.8% in the control group (P > .05).

Conclusions: Compared with CTA, EP POCUS in patients suspected of having AD is highly sensitive and specific and has shown no adverse effect on the treatment start-up time, in-hospital mortality, and mortality within 3 months after discharge.

Keywords: aortic dissection; early screening; point-of-care ultrasound.

MeSH terms

  • Aneurysm, Dissecting* / diagnostic imaging
  • China
  • Emergency Service, Hospital
  • Humans
  • Physicians*
  • Pilot Projects
  • Point-of-Care Systems
  • Prospective Studies
  • Ultrasonography