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

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

We performed a retrospective cohort study of 702 consecutive patients with AAD admitted to the emergency department of a tertiary hospital in China between January 1 and November 23, 2024. Heart rate was categorized as bradycardia (<60 bpm), normal (60-100 bpm), or tachycardia (>100 bpm). Blood pressure was analyzed per 10-mmHg change. Variables significant in univariate analysis (P < 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.