Emergency physician focused cardiac ultrasound improves diagnosis of ascending XXXX .

@entity1 @entity384 @entity4456 @entity1580
STUDY OBJECTIVE: Ascending @entity1580 (AAD) is an uncommon, time-sensitive, and deadly diagnosis with a nonspecific presentation. Ascending @entity1580 is associated with @entity384 , which can be determined by emergency physician focused cardiac ultrasound (EP FOCUS). We seek to determine if @entity1 who receive EP FOCUS have reduced time to diagnosis for AAD. METHODS: We performed a retrospective review of @entity1 treated at 1 of 3 affiliated emergency departments, March 1, 2013, to @entity4456 , 2015, diagnosed as having AAD. All autopsies were reviewed for missed cases. Primary outcome measure was time to diagnosis. Secondary outcomes were time to disposition, misdiagnosis rate, and mortality. RESULTS: Of 386547 ED visits, targeted review of 123 medical records and 194 autopsy reports identified 32 @entity1 for inclusion. Sixteen @entity1 received EP FOCUS and 16 did not. Median time to diagnosis in the EP FOCUS group was 80 (interquartile range [IQR], 46-157) minutes vs 226 (IQR, 109-1449) minutes in the non-EP FOCUS group (P = .023). Misdiagnosis was 0% (0/16) in the EP FOCUS group vs 43.8% (7/16) in the non-EP FOCUS group (P = .028). Mortality, adjusted for do-not-resuscitate status, for EP FOCUS vs non-EP FOCUS was 15.4% vs 37.5% (P = .24). Median rooming time to disposition was 134 (IQR, 101-195) minutes for EP FOCUS vs 205 (IQR, 114-342) minutes for non-EP FOCUS (P = .27). CONCLUSIONS: @entity1 who receive EP FOCUS are diagnosed faster and misdiagnosed less compared with @entity1 who do not receive EP FOCUS. We recommend assessment of the thoracic aorta be performed routinely during cardiac ultrasound in the emergency department.
