Application of the aortic dissection detection risk score in rapid screening in emergency triage of patients with aortic dissection

doi:10.3877/cma.j.issn.1674-0793.2021.05.007

Abstract

Abstract:

Objective

To investigate the application of aortic dissection detection risk score (ADD-RS) in rapid triage of acute aortic dissection (AD).

Methods

From January 2018 to December 2019, 318 patients with acute chest and back pain or abdominal pain in the First Affiliated Hospital of Sun Yat-sen University were evaluated with ADD-RS. Aortic enhanced CT examination was the golden standard for the diagnosis of aortic dissection. The preliminary screening results of ADD-RS were compared with the diagnostic results of aortic enhanced CT.

Results

After initial screening by ADD-RS, 50 patients were diagnosed with AD (AD group) and 268 patients were diagnosed with non-AD (non-AD group) by aortic enhanced CT examination. The general clinical information and ADD risk scores of the two groups were compared. The results showed that the hypertension rate, BMI and pain score in AD group were significantly higher than those in non-AD group (P<0.05). AD group were younger and the proportion of diabetes was lower than those in non-AD group (P<0.05). The ADD-RS of AD group was significantly higher than that of non-AD group, and the difference was statistically significant (P<0.05). The maximum area under the ROC curve for AD predicted by ADD-RS was 0.852 (95% CI: 0.796-0.908), and its sensitivity and specificity were 0.940 and 0.373 respectively.

Conclusion

ADD-RS deserves as an early and reliable screening tool for acute AD in emergency triage.

Key words: Aneurysm, Dissection, Risk factors, Emergency treatment

Yuee Chen, Liqing Xu, Donghua Wei, Yuan Li, Jihong Li. Application of the aortic dissection detection risk score in rapid screening in emergency triage of patients with aortic dissection[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(05): 349-352.

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References 16

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分类	危险因素	分值
高度危险诱发因素	马凡综合征	1
	主动脉疾病家族史
	已知的主动脉瓣疾病
	已知的胸主动脉瘤
	近期主动脉操作史
高度危险疼痛特征	突发性疼痛	1
	剧烈疼痛
	刀割样或撕裂样疼痛
高度危险体征	脉搏短绌或收缩压差异^a	1
	局限性神经功能缺损
	主动脉关闭不全性杂音
	低血压或休克状态

分类	危险因素	分值
高度危险诱发因素	马凡综合征	1
	主动脉疾病家族史
	已知的主动脉瓣疾病
	已知的胸主动脉瘤
	近期主动脉操作史
高度危险疼痛特征	突发性疼痛	1
	剧烈疼痛
	刀割样或撕裂样疼痛
高度危险体征	脉搏短绌或收缩压差异^a	1
	局限性神经功能缺损
	主动脉关闭不全性杂音
	低血压或休克状态

指标		AD组(50例)	非AD组(268例)	统计值	P值
年龄(岁)		52.9±10.2	67.5±13.2	5.916	<0.001^a
男性[例(%)]		39(78.0)	171(63.8)	3.785	0.052
体质指数(kg/m²)		27.32±7.4	23.72±5.2	0.160	<0.001^a
既往史[例(%)]
	吸烟	15(30.0)	109(40.7)	2.017	0.156
	饮酒	5(10.0)	26(9.7)	0.004	0.948
	高血压病	37(74.0)	166(61.9)	2.655	<0.001
	糖尿病	6(12.0)	73(27.2)	5.241	0.022
	卒中	3(6.0)	16(6.0)	<0.001	0.993
入院体征
	收缩压(mmHg)	134.2±19.8	141.0±30.9	12.165	0.139^a
	舒张压(mmHg)	75.7±13.3	78.8±16.8	1.700	0.219^a
	心率(次/分)	90.7±99.78	80.8±20.35	4.643	0.485^a

指标		AD组(50例)	非AD组(268例)	统计值	P值
年龄(岁)		52.9±10.2	67.5±13.2	5.916	<0.001^a
男性[例(%)]		39(78.0)	171(63.8)	3.785	0.052
体质指数(kg/m²)		27.32±7.4	23.72±5.2	0.160	<0.001^a
既往史[例(%)]
	吸烟	15(30.0)	109(40.7)	2.017	0.156
	饮酒	5(10.0)	26(9.7)	0.004	0.948
	高血压病	37(74.0)	166(61.9)	2.655	<0.001
	糖尿病	6(12.0)	73(27.2)	5.241	0.022
	卒中	3(6.0)	16(6.0)	<0.001	0.993
入院体征
	收缩压(mmHg)	134.2±19.8	141.0±30.9	12.165	0.139^a
	舒张压(mmHg)	75.7±13.3	78.8±16.8	1.700	0.219^a
	心率(次/分)	90.7±99.78	80.8±20.35	4.643	0.485^a

组别	例数	轻度疼痛	中度疼痛	重度疼痛	χ²值	P值
AD组	50	4(8.0)	13(26.0)	33(66.0)	58.846	<0.01
非AD组	268	93(34.7)	132(49.3)	43(16.0)

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