A sinister needle in an enormous haystack: A clinician survey regarding Acute Aortic Syndrome diagnostic practice in United Kingdom Emergency Departments

Acute Aortic Syndrome (AAS) is a life-threatening condition associated with high diagnostic uncertainty. This results in an unacceptable number of missed cases, which contributes to its high mortality. We designed and distributed a survey to Emergency Departments (EDs) across the United Kingdom to establish the standard practice for investigation and diagnosis of AAS across the UK. 56 EDs across the UK responded. The majority of these did not have a formal work-up pathway for AAS. The estimated CT scanning rates and missed cases of AAS were highly variable between departments. This suggests variation in practice and diagnostic uncertainty. Given its time sensitive nature, the need for a more standardised diagnostic pathway for AAS in EDs is evident. This may aid clinicians rule out AAS more safely and reduce the number of missed cases, which would in turn reduce the high morbidity and mortality associated with AAS.

急性主动脉综合征（AAS）是一种危及生命的疾病，诊断不确定性高。这导致大量病例漏诊，这也是其高死亡率的原因之一。我们设计并向英国各地的急诊科发放了一份调查问卷，以确定英国各地对AAS进行检查和诊断的标准做法。英国各地有56个急诊科做出了回应。其中大多数科室没有针对AAS的正规检查流程。不同科室之间，AAS的预计CT扫描率和漏诊病例数差异很大。这表明实践操作存在差异以及诊断具有不确定性。鉴于AAS的时间敏感性，很明显急诊科需要一种更标准化的AAS诊断流程。这可能有助于临床医生更安全地排除AAS，并减少漏诊病例数，进而降低与AAS相关的高发病率和死亡率。