Characteristics of patients with ruptured abdominal aortic aneurysm who contacted out-of-hours primary care: a case-control study
Dublin Core
Title
Characteristics of patients with ruptured abdominal aortic aneurysm who contacted out-of-hours primary care: a case-control study
Subject
Ruptured abdominal aortic aneurysm, Triage, Primary care, Out-of-hours primary care services, Emergency medicine
Description
Abstract
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.
Keywords Ruptured abdominal aortic aneurysm, Triage, Primary care, Out-of-hours primary care services, Emergency
medicine
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.
Keywords Ruptured abdominal aortic aneurysm, Triage, Primary care, Out-of-hours primary care services, Emergency
medicine
Creator
Carline J. van den Dries1*, Dave A. Dongelmans2
, Maarten J. van der Laan3
, Sonja Oomkens4
, Eva Ouwendijk5
,
Annelies Visser6
, Frans H. Rutten1
and Dorien L. M. Zwart1
, Maarten J. van der Laan3
, Sonja Oomkens4
, Eva Ouwendijk5
,
Annelies Visser6
, Frans H. Rutten1
and Dorien L. M. Zwart1
Date
2025
Contributor
Peri Irawan
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Collection
Citation
Carline J. van den Dries1*, Dave A. Dongelmans2
, Maarten J. van der Laan3
, Sonja Oomkens4
, Eva Ouwendijk5
,
Annelies Visser6
, Frans H. Rutten1
and Dorien L. M. Zwart1, “Characteristics of patients with ruptured abdominal aortic aneurysm who contacted out-of-hours primary care: a case-control study,” Repository Horizon University Indonesia, accessed April 20, 2026, https://repository.horizon.ac.id/items/show/13269.