A six-year observational study on acute limb ischaemia in a local emergency department in Hong Kong

Abstract

Introduction: Acute limb ischaemia is an important presentation to accident and emergency department (AED). This study aimed to find out the sensitivity of AED colleagues on diagnosing acute limb ischaemia and any association between delayed diagnosis and poor outcome. Prognostic factors that might be associated with amputation and mortality rates were also investigated. Methods: This was a retrospective observational study of patients admitted to Kwong Wah Hospital with a diagnosis of acute limb ischaemia over a six-year period. The risk factors for acute limb ischaemia, the sensitivity of reaching the diagnosis at AED, and outcome in terms of amputation and 30-day mortality post-admission were assessed. Results: The sensitivity of Kwong Wah Hospital AED in diagnosing acute limb ischaemia was 78.3%. Advanced age, lower limb involvement and history of aortic graft were associated with higher risk of mortality. Patients diagnosed and referred by other sources, e.g. private practitioner, were also associated with higher mortality. Male sex, smoking and intravenous drug abuse were associated with higher amputation rate. Atrial fibrillation seemed to be a protective factor against amputation. Delayed diagnosis group comprised 22% of the cases. There was no significant difference in amputation and mortality rates between the early diagnosis and delayed diagnosis groups. Conclusions: AED physicians should always include acute limb ischaemia into the list of differential diagnoses. Further larger scale studies may be performed to investigate the impact of delay in diagnosis on outcome of patients.