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Background <p>Ruptured abdominal aortic aneurysm (rAAA) is rare but it is the second most frequently missed diagnosis reported as sentinel adverse event (‘calamity’) at out-of-hours services in primary care (OHS-PC).</p> <p>We aimed to identify characteristics that could be useful for telephone triage of suspected rAAA at the OHS-PC.</p> Methods <p>In a matched case-control study (1:4 ratio), we compared patients with a missed rAAA (cases) to patients with the same age and sex, and with similar entrance complaint (controls). Data were collected from OHS-PC triage call recordings that were re-assessed by researchers blinded to the case-control status. Patient and call characteristics were univariably assessed with conditional logistic regression analysis.</p> Results <p>Twenty cases of missed rAAA between 2013 and 2023 were matched to 80 controls. 40% of the cases presented with abdominal pain, and 35% with back pain. Cases compared to controls more often had a pain onset &lt; 12&#xa0;h (odds ratio (OR) 15.2; 95%CI 1.9-123.8), reported more sweating (OR 10.1; 95% CI 1.2–86.9, <i>p</i> = 0.035), more often verbally expressed their concern (OR 13.6; 95%CI 3.0-61.3, <i>p</i> = 0.001), and more often called during the night (OR 3.8; 95% CI 1.1–12.7, <i>p</i> = 0.029).</p> Conclusions <p>Recognition of rAAA at the OHS-PC remains challenging given its rare occurrence and lack of specific symptoms. Nevertheless, this case-control study identified factors that could be useful in triage of patients calling the OHS-PC with symptoms possibly indicating rAAA.</p>

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Characteristics of patients with ruptured abdominal aortic aneurysm who contacted out-of-hours primary care: a case-control study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月2日

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  • Carline J. van den Dries,
  • Dave A. Dongelmans,
  • Maarten J. van der Laan,
  • Sonja Oomkens,
  • Eva Ouwendijk,
  • Annelies Visser,
  • Frans H. Rutten,
  • Dorien L. M. Zwart

摘要

Background

Ruptured abdominal aortic aneurysm (rAAA) is rare but it is the second most frequently missed diagnosis reported as sentinel adverse event (‘calamity’) at out-of-hours services in primary care (OHS-PC).

We aimed to identify characteristics that could be useful for telephone triage of suspected rAAA at the OHS-PC.

Methods

In a matched case-control study (1:4 ratio), we compared patients with a missed rAAA (cases) to patients with the same age and sex, and with similar entrance complaint (controls). Data were collected from OHS-PC triage call recordings that were re-assessed by researchers blinded to the case-control status. Patient and call characteristics were univariably assessed with conditional logistic regression analysis.

Results

Twenty cases of missed rAAA between 2013 and 2023 were matched to 80 controls. 40% of the cases presented with abdominal pain, and 35% with back pain. Cases compared to controls more often had a pain onset < 12 h (odds ratio (OR) 15.2; 95%CI 1.9-123.8), reported more sweating (OR 10.1; 95% CI 1.2–86.9, p = 0.035), more often verbally expressed their concern (OR 13.6; 95%CI 3.0-61.3, p = 0.001), and more often called during the night (OR 3.8; 95% CI 1.1–12.7, p = 0.029).

Conclusions

Recognition of rAAA at the OHS-PC remains challenging given its rare occurrence and lack of specific symptoms. Nevertheless, this case-control study identified factors that could be useful in triage of patients calling the OHS-PC with symptoms possibly indicating rAAA.