Missed opportunities for the detection of abdominal aortic aneurysms

Abstract

Objective: To determine whether patients attending as emergencies with ruptured AAA could have been detected opportunistically prior to rupture.

Design: Retrospective analysis.

Methods: The notes of patients attending hospital with ruptured abdominal aortic aneurysms to four City and DGH hospital in the West of Scotland were examined for previous assessments or investigations with the potential to discover an AAA.

Results: In this series 77% of patients were not previously known to have and AAA. Of these patients 76% had been reviewed in hospital during the preceding 5 years on a combined total of 355 occasions. 56% of patients had been seen in hospital during the year preceding rupture on a total of 80 occasions, only undergoing 17 abdominal examinations.

Conclusion: Clinical examination is not frequently considered in routine practice as a screening tool for AAA but patients who subsequently go on to attend as an emergency ruptured AAA are likely to have consulted medical staff during the preceding years. A large number of patients have missed a prior opportunity for detection.