Acute Thoracic Aortic Dissection: A Retrospective Study at an Urban ED in Australia.

Background Thoracic aortic dissection (TAD) is a rare but often fatal condition if left undiagnosed. This study reviewed the detection rate and clinical presentations of TAD in an urban Australian ED. Methods A retrospective observational study was conducted from October 30, 2018 to March 30, 2023. The hospital imaging database (InteleViewer) was searched for radiology reports containing "aorta" or "aortic" together with "dissection" or the misspelling "disection." The search identified 25 patients with acute TAD who presented to the ED. Medical records were reviewed, and the Aortic Dissection Detection Risk Score (ADD-RS) was applied retrospectively. Cases missed in the ED were also reviewed. Results Nineteen cases (76%) were type A, and six (24%) were type B, corresponding to 8.6 cases per 100,000 ED visits. Hypertension was the most common risk factor (64%). Pain presentations varied, with only five patients (20%) experiencing classic, sudden-onset central chest pain radiating to the back. TAD was diagnosed by CT aortography in 22 cases (88%). Chest radiography was performed in 12 patients and showed signs of TAD in six (50%). Bedside echocardiography was performed in 12 cases and detected TAD in one-third. The median time from ED arrival to surgical intervention was 230 minutes (IQR, 165-480 minutes). Fifteen patients (60%) had an ADD-RS ≤1; however, most did not undergo D-dimer testing. One case was initially missed in the ED but was subsequently diagnosed after hospital admission and had a favourable outcome. Conclusions Our study demonstrates the variability in the presenting features of TAD. Within this cohort, patients with confirmed TAD experienced short intervention times and favourable outcomes. The absence of classic symptoms and ADD-RS features does not exclude a diagnosis of TAD. Improving staff education regarding key symptoms and signs may enhance early detection.