Predictive value of initial triage vital signs for in-hospital mortality in acute aortic dissection patients: a retrospective study in the emergency department

Résumé fourni par la source

Background: Acute aortic dissection (AAD) is a life-threatening emergency requiring rapid diagnosis and treatment. Vital signs obtained at triage are immediately available and may provide useful information for early risk stratification. Objectives: To evaluate whether triage vital signs are independently associated with in-hospital mortality in patients with AAD, with a specific focus on analyzing heart rate as a categorical variable and blood pressure in clinically relevant units. Methods: < 0.10) were entered into a multivariate model. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) with 10-fold cross-validation. Results: Among 702 patients, 293 (41.7%) died during hospitalization. Multivariate logistic regression identified older age (adjusted OR 1.029 per year, 95% CI 1.017-1.041), male sex (adjusted OR 1.495, 95% CI 1.036-2.157), bradycardia (adjusted OR 2.500, 95% CI 1.300-4.800), tachycardia (adjusted OR 1.800, 95% CI 1.100-2.900), lower body temperature (adjusted OR 1.499 per 1 °C decrease, 95% CI 1.082-2.075), and higher diastolic blood pressure (adjusted OR 1.105 per 10-mmHg increase, 95% CI 1.001-1.220) as independent risk factors for in-hospital mortality. The model demonstrated acceptable discrimination (mean cross-validated AUC 0.71, 95% CI 0.68-0.74). Conclusion: Initial triage vital signs, particularly deviations in heart rate (both low and high), lower body temperature, and higher diastolic blood pressure, are independent predictors of in-hospital mortality in patients with AAD. Assessing these readily available parameters can support early risk stratification in the emergency department.

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