LAUSR

OBJECTIVE To investigate the rate of misdiagnosis in the emergency department (ED) in patients with ruptured abdominal aortic aneurysms (rAAAs), and to investigate how misdiagnosis affects rAAA mortality. METHOD Data were extracted from the Swedish Cause of Death Registry and the Swedish National Registry for Vascular Surgery (Swedvasc), 2010‒2015. All rAAA patients registered in the healthcare system in the west of Sweden were identified. Medical charts for rAAA patients were reviewed, and patients who were correctly diagnosed at the first assessment in the ED were compared to patients who were misdiagnosed. RESULTS Altogether, 455 patients with rAAA were identified, including both patients who underwent surgery and those who did not. One hundred seventy-seven (38.9%) were initially misdiagnosed. The mortality rate was 74.6% in patients who were misdiagnosed, as compared to 62.9% in correctly diagnosed patients (p=0.01). The adjusted odds ratio for mortality in misdiagnosed patients relative to correctly diagnosed patients was 1.83 (95% CI 1.13‒2.96) (p=0.01). When excluding patients offered palliative care (n=134) after detection of the rAAA, the mortality in initially misdiagnosed patients was 65.1% as compared to 46.4% in correctly diagnosed patients (p=0.001). In patients reaching surgical intervention, 37 (45.1%) of the primarily misdiagnosed patients died (30-day or in hospital mortality) as compared to 63 (38.0%) of the correctly diagnosed (p=0.34). CONCLUSION Misdiagnosis is common in patients with rAAA, and it is associated with a substantially higher risk of dying from the ruptured aneurysm.