QUALITY OF HISTORY TAKING IN PATIENTS WITH AORTIC DISSECTION

Studly objectives: Aortic dissection generally is an acute catastrophe . Rapid diagnosis is critical, We hypothesized that the quality of his tory taking contributes to the accuracy of diagnosis in patients with dissection. Design: Retrospective chart review of 83 patients, whose d iagnosis of aortic dissection was confirmed by autopsy, surgery, CT sc an, echocardiogram, or angiogram, The quality of the initial history w as reviewed using predetermined criteria. The physicians' initial clin ical impressions were recorded. Results: The examining physician corre ctly suspected aortic dissection after the initial clinical evaluation in 54 of 83 patients (65%). Only 33 of 78 patients with symptoms (42% ) were asked about the quality, location, and onset of their pain, the three descriptors identified a priori as important. In 19 patients (2 4%), only zero or one descriptor was recorded. When all three question s rr ere asked, dissection was suspected in 30 of 33 patients (91%); w hen zero, one, or two questions were asked, dissection was suspected i n 22 of 45 patients (49%). Concllrsion: Despite important advances in diagnostic imaging, accurate diagnosis of aortic dissection requires a n accurate history. In our series, the quality of initial history was associated with the accuracy of the initial clinical impression in pat ients with aortic dissection.