评估当前的急性主动脉综合征路径:急性主动脉综合征合作项目(CAASP)。

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae096
Jim Zhong, Aminder A Singh, Nawaz Z Safdar, Sandip Nandhra, Ganesh Vigneswaran
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引用次数: 0

摘要

背景:急性主动脉综合征的诊断具有挑战性,且与较高的院周死亡率相关。研究旨在评估当前的路径,了解急性主动脉综合征患者护理的时序:采用预先确定的搜索策略,对2018年1月1日至2021年6月1日期间影像诊断为急性主动脉综合征的连续患者进行识别,并通过回顾性病例记录审查进行为期6个月的随访。英国国家介入放射学受训者研究和血管及血管内研究网络对该研究进行了协调:英国 15 个研究机构共招募了 620 名患者。中位年龄为 67 岁(25-98 岁不等),62.0% 为男性,92.9% 为白种人。最常见的是A型夹层(41.8%),其次是B型(34.5%);41.2%的患者患有复杂的急性主动脉综合征。就诊方式包括急诊救护车(80.2%)、自行就诊(16.2%)和基层医疗机构转诊(3.6%)。到医院就诊的时间(中位数)为 3.1(1.8-8.6)小时,突发胸痛缩短了就诊时间,而移动性疼痛或高血压则延长了就诊时间。从入院到影像学诊断的时间为 3.2(1.3-6.5)小时,有主动脉疾病家族史的患者所需时间增加,同时患有缺血性肢体疾病的患者所需时间减少。从诊断到治疗的时间为2(1.0-4.3)小时,医院间转院导致了时间延误。治疗方法包括保守治疗(60.2%)、开放手术(32.2%)、血管内治疗(4.8%)、混合治疗(1.4%)和姑息治疗(1.4%)。30天和6个月内死亡率较高的相关因素是急性主动脉综合征类型、病情复杂、未入住重症监护室和年龄超过70岁(P<0.05):本研究提供了一个纵向数据集,将诊断和治疗的时间延迟与临床结果联系起来。结论:该研究提供的纵向数据集将诊断和治疗的时间延误与临床结果联系起来,可用于确定研究策略的优先次序,以简化患者护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluating current acute aortic syndrome pathways: Collaborative Acute Aortic Syndrome Project (CAASP).

Background: Diagnosis of acute aortic syndrome is challenging and associated with high perihospital mortality rates. The study aim was to evaluate current pathways and understand the chronology of acute aortic syndrome patient care.

Method: Consecutive patients with acute aortic syndrome imaging diagnosis between 1 January 2018 and 1 June 2021 were identified using a predetermined search strategy and followed up for 6 months through retrospective case note review. The UK National Interventional Radiology Trainee Research and Vascular and Endovascular Research Network co-ordinated the study.

Results: From 15 UK sites, 620 patients were enrolled. The median age was 67 (range 25-98) years, 62.0% were male and 92.9% Caucasian. Type-A dissection (41.8%) was most common, followed by type-B (34.5%); 41.2% had complicated acute aortic syndrome. Mode of presentation included emergency ambulance (80.2%), self-presentation (16.2%), and primary care referral (3.6%). Time (median (i.q.r.)) to hospital presentation was 3.1 (1.8-8.6) h and decreased by sudden onset chest pain but increased with migratory pain or hypertension. Time from hospital presentation to imaging diagnosis was 3.2 (1.3-6.5) h and increased by family history of aortic disease and decreased by concurrent ischaemic limb. Time from diagnosis to treatment was 2 (1.0-4.3) h with interhospital transfer causing delay. Management included conservative (60.2%), open surgery (32.2%), endovascular (4.8%), hybrid (1.4%) and palliative (1.4%). Factors associated with a higher mortality rate at 30 days and 6 months were acute aortic syndrome type, complicated disease, no critical care admission and age more than 70 years (P < 0.05).

Conclusions: This study presents a longitudinal data set linking time-based delays to diagnosis and treatment with clinical outcomes. It can be used to prioritize research strategies to streamline patient care.

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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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