Evidence map›Paper›PMID 40841784›Full record

ArticleCJEM2025

Aortic dissection in the ED: a medico-legal perspective on diagnostic delays and failures.

Jacqueline H Fortier, Mehrnaz Mostafapour, Robert Ohle, Kate Barbosa, Richard Liu, Ming Guo, Gary E Garber, Heather E Murray

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in CJEM, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Jacqueline H FortierThe Canadian Medical Protective Association, Ottawa, ON, Canada.
Mehrnaz MostafapourThe Canadian Medical Protective Association, Ottawa, ON, Canada.
Robert OhleNorthern Ontario School of Medicine, Sudbury, ON, Canada.
Kate BarbosaThe Canadian Medical Protective Association, Ottawa, ON, Canada.
Richard LiuThe Canadian Medical Protective Association, Ottawa, ON, Canada.
Ming GuoUniversity of Ottawa Heart Institute, Ottawa, ON, Canada.
Gary E GarberThe Canadian Medical Protective Association, Ottawa, ON, Canada.
Heather E MurrayThe Canadian Medical Protective Association, Ottawa, ON, Canada. hmurray@cmpa.org.ORCID 0000-0002-8448-2566

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAortic dissection is a life-threatening emergency and delayed or missed diagnoses can result in significant morbidity and mortality for patients.

methodsWe conducted a quantitative and qualitative analysis of medico-legal cases from a national repository involving thoracic aortic dissection seen in the emergency department during a 10-year period. We thematically analyzed peer expert criticism of the care in these cases, including provider, team, and systems factors related to diagnostic issues. We also applied two clinical decision tools to explore whether use of these tools could have affected the diagnostic process.

resultsOf 3,531 medico-legal cases in the emergency department during our study period, just 43 were related to aortic dissection. Patients were primarily male (68.2%), presented for care at large urban centers (65.1%), and were triaged as urgent or emergent (72.1%). Thirty-six patients died of their aortic dissection. A thematic analysis identified atypical presentations, diagnostic anchoring, misinterpretation or misuse of tests, communication breakdowns, and resource limitations as common in these cases.

conclusionsMissed diagnoses of aortic dissection in the ED often result from a combination of cognitive, communication, and system-level factors. Understanding these contributors can inform evidence-based, systems-level supports and strategies to enhance diagnostic accuracy and reduce patient harm.

Indexed as

Aortic Aneurysm, ThoracicAortic DissectionDelayed DiagnosisDiagnostic ErrorsEmergency Service, HospitalAgedFemaleHumansMaleMiddle AgedMissed DiagnosisRetrospective StudiesAcute aortic syndromeAortic dissectionDiagnostic delayDiagnostic error

Identifiers

PMID40841784
PMCPMC12628382

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.