When to activate a multidisciplinary team for an acute abdominal aortic aneurysm?

Abstract

Background: It is often difficult to determine when a multidisciplinary aneurysm team should be summoned based on the (often limited) pre-hospital information provided

Method: We performed a retrospective cohort study of patients brought to our hospital between January 1st 2013 and October 1st 2014 by the emergency medical services (EMS) with a clinical suspicion of an acute AAA. Within this group we compared patients with a documented acute AAA and without an acute AAA in order to identify patient characteristics that could be used for the development of evidence based activation criteria for multidisciplinary acute aneurysm teams.

Results: Of the 63 patients presented by the EMS with a clinical suspicion of an acute AAA, 16 had an acute AAA. The optimal age cut-off value to discriminate patients with- from patients without an acute AAA was 70 years, whereas the optimal cut-off systolic blood pressure was 137 mmHg. "Age> 70" (LR+ 2.6 [1.8-3.8], "SBP <137mm Hg" (LR+ 2.6 [1.5-4.9], the "presence of diaphoresis " (LR+ 2.5 [1.7-3.8] and a "prior history of AAA" (LR+ 2.9 [1.5-5.7] were independent predictors of the presence of an acute AAA. The presence of any of these factors increased the pre-test probability of an acute AAA to > 50%.

Conclusion: Pre-hospital information regarding the patient's age, history (known AAA), blood pressure and general appearance (presence of diaphoresis) can be useful when EMS services announce the arrival of a patient with suspected acute AAA in order to improve appropriate triage and minimize time to definitive care.