Report calls for improved detection of aortic dissection

Thursday 23 January 2020

A new report has called for hospitals in England to improve the diagnosis and management of deadly aortic tears.

Today’s report from the Healthcare Safety Investigation Branch (HSIB) also tasks The Royal College of Radiologists (RCR) to help create a national process for better case management of aortic dissection. 

The HSIB review was sparked by the case of a fit 54-year-old patient who went to A&E after experiencing severe chest pain at the gym. Following a five hour wait for a confirmed diagnosis, he sadly died while being transferred to a specialist centre for surgery. 

Rapid treatment is vital to repair a damaged aorta but, according to HSIB, up to half of the 2,500 patients in England who suffer acute aortic dissection each year die before reaching specialist care.

As its most common symptoms are generalised chest and back pain, clinicians can miss the condition and it is not easy to identify on X-ray images. HSIB found that up to 40 per cent of patients had a delay to diagnosis.   

The report recommends that aortic dissection is included into a formal triage system for emergency patients, and it calls on the RCR to work with the Royal College of Emergency Medicine (RCEM) to create a standard process for managing suspected cases.  

Welcoming the HSIB report, the RCR’s Medical Director of Professional Practice for Clinical Radiology Professor Mark Callaway said:

“The HSIB report highlights the devastating, deadly reality of acute aortic dissection, how difficult it can be to recognise and how crucial it is that suspected patients get a rapid CT scan, which is the most effective way for a busy emergency team to confirm the condition. 

“We very much welcome the opportunity to work with RCEM on defining standards for detecting and managing theses cases, which should have a major impact on the prompt diagnosis of aortic dissection and, ultimately, save lives.”

One hospital that has already implemented an enhanced process for improving clinical awareness and increasing detection of aortic dissection is Bristol Royal Infirmary.

Commenting on the experience of her team, Dr Emma Redfern, consultant in adult emergency medicine at the Bristol Royal Infirmary, added:

“We know that raised awareness among clinicians and set processes around flagging aortic dissection can be implemented successfully in emergency departments. 

“For example, clinicians at the Bristol Royal Infirmary have increased CT scanning of patients with potential aortic dissection to 300 scans annually, from 20 scans in 2009. As a department we have learned that the condition is more common than we had thought, and we are now picking up on average a case every six to eight weeks.”