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2016 ; 57
(3
): 626-34
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Outcomes before and after the Implementation of a Critical Pathway for Patients
with Acute Aortic Disease
#MMPMID26996561
Shin KC
; Lee HS
; Park JM
; Joo HC
; Ko YG
; Park I
; Kim MJ
Yonsei Med J
2016[May]; 57
(3
): 626-34
PMID26996561
show ga
PURPOSE: Acute aortic diseases, such as aortic dissection and aortic aneurysm,
can be life-threatening vascular conditions. In this study, we compared outcomes
before and after the implementation of a critical pathway (CP) for patients with
acute aortic disease at the emergency department (ED). MATERIALS AND METHODS:
This was a retrospective observational cohort study. The CP was composed of two
phases: PRE-AORTA for early diagnosis and AORTA for prompt treatment. We compared
patients who were diagnosed with acute aortic disease between pre-period (January
2010 to December 2011) and post-period (July 2012 to June 2014). RESULTS:
Ninety-four and 104 patients were diagnosed with acute aortic disease in the pre-
and post-periods, respectively. After the implementation of the CP, 38.7% of
acute aortic disease cases were diagnosed via PRE-AORTA. The door-to-CT time was
reduced more in PRE-AORTA-activated patients [71.0 (61.0, 115.0) min vs. 113.0
(56.0, 170.5) min; p=0.026]. During the post-period, more patients received
emergency intervention than during the pre-period (22.3% vs. 36.5%; p=0.029).
Time until emergency intervention was reduced in patients, who visited the ED
directly, from 378.0 (302.0, 489.0) min in the pre-period to 200.0 (170.0, 299.0)
min in the post-period (p=0.001). The number of patients who died in the ED
declined from 11 to 4 from the pre-period to the post-period. Hospital mortality
decreased from 26.6% to 14.4% in the post-period (p=0.033). CONCLUSION: After the
implementation of a CP for patients with acute aortic disease, more patients
received emergency intervention within a shorter time, resulting in improved
hospital mortality.