HSIB: Investigation into delayed recognition of acute aortic dissection (23 January 2020)

Summary

The aorta is the largest artery in the body. Acute dissection occurs when a spontaneous tear allows blood to flow between the layers of the wall of the aorta, which may then rupture with catastrophic consequences. There are about 2,500 cases per year in England, with around 50% of patients dying before they reach a specialist centre for care and 20-30% of patients dying before they reach any hospital.

This Healthcare Safety Investigation Branch (HSIB) report highlights the difficulty which can face hospital staff in recognising acute aortic dissection. Although sudden severe chest or back pain is the most common symptom, the picture can vary or mimic other conditions, which may lead to an incorrect diagnosis or delays in recognising a life-threatening condition which needs urgent treatment.

Content

Safety recommendations

HSIB have made two safety recommendations to help improve the recognition of acute aortic dissection:

• The first is to add ‘aortic pain’ to the list of possible presenting features included in the triage systems used to prioritise patients attending emergency departments.
• The second recommends the development of an effective national process to help staff in emergency departments detect and manage this condition.