Leave a comment
July 29, 2014 by dailybolusoflr
By Julie Rice, MD
Rosman HS, Patel S, et al. Quality of history taking in patients with aortic dissection. Chest 1998 Sep;114(3)
Design: Retrospective chart review, 83 patients with confirmed Aortic dissection (autopsy, surgery, CT scan, echo, angio). Looked at history and physician initial charted impressions.
Results: The examining physician correctly 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 intensity at onset of their pain, the three descriptors identified a priori as important. In 19 patients (24%), only zero or one descriptor was recorded. When all three questions were asked, dissection was suspected in 30 of 33 patients (91%); when zero, one, or two questions were asked, dissection was suspected in 22 of 45 patients (49%).
Conclusion: Accurate history associated with accuracy on initial clinical impression
This paper is cited commonly in literature and lecture on Aortic Dissection emphasizing the importance of history taking in chest pain patients
This paper is also cited in several national presentations on common litigation themes and ways to protect yourself. Stresses importance of listing negatives “no radiation to back, no sudden/severe onset” to show that you considered aortic dissection in your differential while taking your history. Failure to do so can be interpreted as you not considering aortic dissection in your history.