Ruptured abdominal aortic aneurysm: a 7-year retrospective observational study in an emergency department of Hong Kong

Objectives: To review the clinical presentations and outcomes of patients with ruptured abdominal aortic aneurysm (AAA) in a regional hospital and its evaluation in the accident and emergency department (AED). Methods: This is a retrospective observational study of patients admitted through the AED with the discharge or post-mortem diagnosis of ruptured AAA from 1st January 2002 to 31st December 2008 in a regional pubic hospital of Hong Kong. Their demographic and clinical data were recorded and analysed. The sensitivity of the AED in detecting ruptured AAA or symptomatic AAA was evaluated. Results: Twenty-six patients were found to have ruptured AAA and included in the study. All were Chinese. Seventeen patients had repair surgery done by open surgical method. Eighteen (69%) patients were diagnosed to have ruptured AAA or found to have symptomatic AAA in the AED. Three (12%) ruptured AAAs were diagnosed at postmortem. The most common presenting symptoms were abdominal pain (73%) and loss of consciousness (46%). Only five (19%) patients had the classical triad of abdominal pain, haemorrhagic shock and a pulsatile abdominal mass. Ultrasound of aorta was performed in 74% of cases in the group with ruptured AAA or symptomatic AAA diagnosed in the AED but none in the delayed diagnosis group (p=0.001). The former group were 3.7 times more likely to proceed to repair surgery (p=0.188) and had surgical repair operation 40.8 hours earlier than the latter group (p=0.006). Systolic blood pressure less than 90 mmHg at any time point before operation was found to correlate significantly with mortality (p=0.029). Conclusion: A high index of suspicion and prompt recognition of ruptured AAA is of paramount importance. Emergency physicians should familiarise themselves with the clinical presentation and management of patients with ruptured AAA. Emergency ultrasound performed in the AED helps in the early detection of AAA. (Hong Kong j.emerg.med. 2010;17:118-125)