P1.48 Aortic Dissections: Why a Patient has to Wait (Moscow-Based Retrospective Study)

Abstract

Aortic dissections (AD) are considered among most serious life-threatening conditions requiting emergency medical intervention. However, delays in recognition and treatment often occurred.

Our aim was to determine mean time intervals between 1) fist symptoms appearance (diagnostic delay, DD), 2) first contact with a doctor (Doctor-related delay, DRD) and final establishing of a confirmed diagnosis.

We analyzed 37 cases of patients admitted to general hospital with AD (84.6% males, mean age — 58.3 years).

Type A AD occured in 58.9% cases, type B - in 41.1%. The most frequent risk factors were atherosclerosis and hypertension, 94.8%. We identified 1 case of Marfan syndrome and 1 case lues tertiariai. Thoracic pain was observed in all cases: 38% patients complained of back pain and 84,6 % of anterior chest pain. Abnormal pulsation and murmurs were found in 33.3% and 25.6% of patients respectively. The DD was 1–23 days (mean 12.4), DRD was 1– 16 days (mean 9.5).DD and DRD were significantly increased in patients of 70 years of age and older and in patients with combined pathology, including coronary heart disease (p<0.043, p<0.14 respectively).

Majority of the DD and DRD delays were due to either masked symptoms or blurred clinical picture, or inadequate use of existing diagnostic facilities. More attention should be paid to postgraduate continuous medical education both of GPs referring patients to a hospital and of hospital-based staff.