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Article Abstract
Background: Ruptured abdominal aortic aneurysm (rAAA) is rare but it is the second most frequently missed diagnosis reported as sentinel adverse event ('calamity') at out-of-hours services in primary care (OHS-PC). We aimed to identify characteristics that could be useful for telephone triage of suspected rAAA at the OHS-PC.
Methods: In a matched case-control study (1:4 ratio), we compared patients with a missed rAAA (cases) to patients with the same age and sex, and with similar entrance complaint (controls). Data were collected from OHS-PC triage call recordings that were re-assessed by researchers blinded to the case-control status. Patient and call characteristics were univariably assessed with conditional logistic regression analysis.
Results: Twenty cases of missed rAAA between 2013 and 2023 were matched to 80 controls. 40% of the cases presented with abdominal pain, and 35% with back pain. Cases compared to controls more often had a pain onset < 12 h (odds ratio (OR) 15.2; 95%CI 1.9-123.8), reported more sweating (OR 10.1; 95% CI 1.2-86.9, p = 0.035), more often verbally expressed their concern (OR 13.6; 95%CI 3.0-61.3, p = 0.001), and more often called during the night (OR 3.8; 95% CI 1.1-12.7, p = 0.029).
Conclusions: Recognition of rAAA at the OHS-PC remains challenging given its rare occurrence and lack of specific symptoms. Nevertheless, this case-control study identified factors that could be useful in triage of patients calling the OHS-PC with symptoms possibly indicating rAAA.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC12403838 | PMC |
| http://dx.doi.org/10.1186/s12245-025-00974-5 | DOI Listing |
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