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Management of patients with acute aortic syndrome through a regional rapid transport system
- Source :
- Journal of Vascular Surgery. 65:21-29
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- The objective of this study was to describe the outcomes of patients with acute aortic syndrome (AAS) during and after transfer to a regional aortic center by a rapid transport system.Review of patients with AAS who were transferred by a rapid transport system to a regional aortic center was performed. Data regarding demographics, diagnosis, comorbidities, transportation, and hospital course were acquired. Severity of existing comorbidities was determined by the Society for Vascular Surgery Comorbidity Severity Score (SVSCSS). The Acute Physiology and Chronic Health Evaluation II (APACHE II) score assessed physiologic instability on admission. Risk factors associated with system-related (transfer and hospital) mortality were identified by univariate and multivariate linear regression analysis.During a recent 18-month period (December 2013-July 2015), 183 patients were transferred by a rapid transport system; 148 (81%) patients were transported by ground and 35 (19%) by air. Median distance traveled was 24 miles (range, 3.6-316 miles); median transport time was 42 minutes (range, 10-144 minutes). Two patients died during transport, one with a type A dissection, the other of a ruptured abdominal aortic aneurysm. There were 118 (66%) patients who received operative intervention. Median time to operation was 6 hours. Type B dissections had the longest median time to operation, 45 hours, with system-related mortality of 1.9%; type A dissections had the shortest median time, 3 hours, and a system-related mortality of 16%. Overall, system-related mortality was 15%. On univariate analysis, factors associated with system-related mortality were age ≥65 years (P = .026), coronary artery disease (P = .030), prior myocardial infarction (P = .049), prior coronary revascularization (P = .002), SVSCSS of8 (P .001), abdominal pain (P = .002), systolic blood pressure 90 mm Hg at sending hospital (P = .001), diagnosis of aortic aneurysm (P = .013), systolic blood pressure 90 mm Hg in the intensive care unit (P .001), and APACHE II score10 (P = .004). Distance traveled and transport mode and duration were not associated with increased risk of system-related mortality. Only SVSCSS of8 (odds ratio, 7.73; 95% confidence interval, 2.32-25.8; P = .001) was independently associated with an increase in system-related mortality on multivariate analysis.Implementation of a rapid transport system, regardless of mode or distance, can facilitate effective transfer of patients with AAS to a regional aortic center. An SVSCSS of8 predicted an increased system-related mortality and may be a useful metric to assess the appropriateness of patient transfer.
- Subjects :
- Male
Time Factors
Regional Medical Programs
030204 cardiovascular system & hematology
Coronary artery disease
Aortic aneurysm
0302 clinical medicine
Catchment Area, Health
Risk Factors
Odds Ratio
Hospital Mortality
030212 general & internal medicine
Myocardial infarction
APACHE
Aged, 80 and over
Acute aortic syndrome
Univariate analysis
APACHE II
Syndrome
Middle Aged
Los Angeles
Aortic Aneurysm
Treatment Outcome
Acute Disease
Cardiology
Centralized Hospital Services
Female
Cardiology and Cardiovascular Medicine
Adult
Patient Transfer
medicine.medical_specialty
Aortic Rupture
Risk Assessment
Time-to-Treatment
03 medical and health sciences
Internal medicine
medicine
Humans
Aged
Retrospective Studies
Chi-Square Distribution
business.industry
Hemodynamics
Odds ratio
medicine.disease
Confidence interval
Surgery
Aortic Dissection
Logistic Models
Multivariate Analysis
Linear Models
Emergencies
business
Delivery of Health Care
Program Evaluation
Subjects
Details
- ISSN :
- 07415214
- Volume :
- 65
- Database :
- OpenAIRE
- Journal :
- Journal of Vascular Surgery
- Accession number :
- edsair.doi.dedup.....08b9cf4578b8414e849d6a9954001354