Misdiagnosis of Ruptured Abdominal Aortic Aneurysm: Systematic Review and Meta-Analysis

Purpose: To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect differential diagnoses. Methods: A systematic search according to PRISMA guidelines was performed using EMBASE and MEDLIN...

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Bibliographic Details
Published in:Journal of endovascular therapy 2014-08, Vol.21 (4), p.568-575
Main Authors: Azhar, Bilal, Patel, Shaneel R., Holt, Peter J.E., Hinchliffe, Robert J., Thompson, Matt M., Karthikesalingam, Alan
Format: Article
Language:English
Subjects:
Aneurysms
Aortic Aneurysm, Abdominal - complications
Aortic Aneurysm, Abdominal - diagnosis
Aortic Aneurysm, Abdominal - therapy
Aortic Rupture - diagnosis
Aortic Rupture - etiology
Aortic Rupture - therapy
Diagnosis, Differential
Diagnostic Errors
Hospitals
Humans
Medical treatment
Mortality
Predictive Value of Tests
Prognosis
Studies
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Summary:Purpose: To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect differential diagnoses. Methods: A systematic search according to PRISMA guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting the initial rate of misdiagnosis of patients with rAAA. Random-effects meta-analyses were performed to estimate the rate of misdiagnosis, presenting features, and commonest differential diagnoses. A sensitivity analysis was performed for studies reporting after 1990. Results: Nine studies comprising 1109 patients contributed to the pooled analysis, which found a 42% incidence of rAAA misdiagnosis (95% CI 29% to 55%). In studies reporting after 1990, misdiagnosis was seen in 32% (95% CI 16% to 49%). The most common erroneous differential diagnoses were ureteric colic and myocardial infarction. Abdominal pain, shock, and a pulsatile mass were presenting features in 61% (49%–72%), 46% (32%–61%), and 45% (29%–62%) of rAAAs, respectively. Conclusion: The rate of misdiagnosis of rAAA has remained consistent over time and is concerning. There is a need for an effective clinical decision tool to enable accurate diagnosis and triage at the scene of the emergency.
ISSN:1526-6028
1545-1550
DOI:10.1583/13-4626MR.1