Acute aortic syndrome (AAS) is a rare but time-dependent emergency, with a linear mortality increase of 2% per hour of diagnostic delay. It is also difficult to diagnose, with a miss rate of 25% and misdiagnosis rates up to 38%. The gold standard for AAS diagnosis is CT imaging. Although CT imaging is readily available in most EDs, it is impractical to CT scan every patient presenting with chest pain for a multitude of reasons, including increased exposures, length of stay, and resource costs. As such, there is a clear need for guidelines that identify patients at risk for AAS, in order to facilitate further workup.
This Clinical Practice Guideline (CPG), developed by Ohle et al. in 20201, allows ED physicians to efficiently categorize patients into risk-stratified groups based on a quick history and physical exam. This CPG was compiled by community and academic ED physicians with extensive clinical and methodological expertise, who utilized the GRADE methodology to adapt pre-existing high-quality clinical practice guidelines from the American Heart Association and European Society of Cardiology.
The CPG presents an easy to follow scoring tool and a clinical decision aid that can help determine next steps of management. There are plans to continue future support for this CPG, including the creation of an online decision support tool and a commitment to update the CPG within 5yrs if new evidence warrants revisions of recommendations.
Our infographic aims to present the highlights of this CPG in an easily digestible format that can be referred to by practicing ED physicians in order to aid in clinical decision-making.
This post was copyedited by Casey Jones (@CaseyMAJones).
- 1.Ohle R, Yan J, Yadav K, et al. Diagnosing acute aortic syndrome: a Canadian clinical practice guideline. CMAJ. 2020;192(29):E832-E843. doi:10.1503/cmaj.200021
Acute aortic syndrome (AAS) is a critical life threatening disease, but a challenging diagnosis to make. While contrast enhanced computed tomography has excellent diagnostic accuracy, choosing the appropriate patients to receive this test is essential to minimizing harm while maximizing likelihood of diagnosing this disease when it occurs. This Canadian clinical practice guideline adds onto and updates existing American Heart Association (2010) and the European Society of Cardiology (2014) guidelines with the latest evidence to provide clinicians with a tool to improve recognition and diagnosis of AAS. This infographic aims to simplify and highlight the key points of the guideline to help improve clinicians who may encounter this pathology.