Ruptured: Retrospective Analysis Undertaken for Patients Treated for Unexplained Retroperitoneal or Abdominal Pain in the Emergency Department.

Abstract

Symptomatic abdominal aortic aneurysms carry significant mortality risk. This is supplemented by the Royal College of Emergency Medicine guidelines which suggest imaging for patients 50 years of age or older presenting with unexplained abdominal, flank, or back pain. This study aimed to evaluate the prevalence and mortality rates of patients with symptomatic abdominal aortic aneurysms in a high-risk population and to assess scanning rates in the accident and emergency department. Retrospective analysis of patients presenting to the accident and emergency department at a district general hospital over 6 months was performed. Patients 50 years of age or older presenting with abdominal, flank, or back pain were included. Collected data points included; whether or not a scan was performed in the emergency department, the modality of imaging, whether an abdominal aortic aneurysm was identified on the scan, the age of patients with an abdominal aortic aneurysms identified on the scan, size of the identified abdominal aortic aneurysms, primary diagnosis at the time of review in the emergency department, and all-cause mortality rates. 361 patients were identified to have an indicated scan, of which only 122 (33.8%) had a scan in the emergency department. In the syndromic group, the prevalence and 30-day mortality of patients with an abdominal aortic aneurysm were 5.5% and 1.1% respectively. Only 12 out of 20 patients with an abdominal aortic aneurysm were identified in the emergency department. The criteria outlined by the Royal College of Emergency Medicine does well at identifying patients with abdominal aortic aneurysms when followed. However, this study reveals that scanning rates in the emergency department are low. The encouragement of scanning and improved ultrasound skills among emergency medicine clinicians can reduce missed diagnoses. Additionally, we recommend further studies to assess the mortality rates of emergent abdominal aortic aneurysm presentations.