Investigation summary

Acute aortic dissection is a relatively rare but life-threatening condition which requires rapid recognition and urgent treatment in a specialist centre. The symptoms and signs can be confusing and aortic dissection may be mistaken for other conditions, leading to delay in diagnosis. 

Anecdotal evidence suggests that a significant proportion of patients do not reach hospital alive but that failure to recognise the condition quickly enough may lead to other deaths which may be potentially avoidable.

The reference event for this investigation was a 54-year-old man who experienced chest pain during exercise and was initially taken to the emergency department of a non-specialist acute hospital. After over four hours in the hospital, the diagnosis of acute aortic dissection was confirmed. The patient was sent by ambulance to a specialist centre for treatment but died on the way there.

This investigation forms the second of two parts based on this event. The first part, ‘Transfer of critically ill adults’, was published in January 2019. This part seeks to understand the factors affecting the recognition of acute aortic dissection, focussing on the role of the emergency department.

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