The AORTA Project (Assessment Of Risk and Testing in Acute Aortic Syndrome) aims to improve the diagnosis of acute aortic syndrome (AAS) in UK emergency departments.

Background
Acute Aortic Syndrome includes life-threatening conditions such as aortic dissection, a tear in the major blood vessel leaving the heart. It affects around 1 in 400 patients with chest, back or abdominal pain, collapse or symptoms of malperfusion who attend the emergency department. Delayed or missed diagnosis are common and carry a high mortality. While CT aortography (CTA) is a definitive test, routine scanning of all potentially affected patients is impractical because of cost, radiation exposure and resource demands. Deciding which patients should proceed to CT scan requires further research.

The Studies
The project explores safer and more efficient diagnostic approaches through four interconnected studies.

AORTA-D is a prospective observational cohort study recruiting 4,000–6,000 patients across approximately 80 UK emergency departments as a collaboration with the TERN (Trainee Emergency Research Network). It will compare clinical gestalt, clinical decision tools and D-dimer strategies to assess whether combinations of risk assessment and D-dimer testing can safely reduce unnecessary CT scanning without increasing missed diagnoses.

AORTA-Q(c) is a qualitative study exploring how emergency clinicians assess AAS risk, manage uncertainty and use diagnostic tools in practice.

AORTA-Q(p) is a qualitative study exploring patient views on acceptable risk, diagnostic uncertainty and attitudes towards CT scanning versus missed diagnosis.

AORTA-R uses retrospective NHS Lothian routine data from DataLoch to examine trends in CT imaging, D-dimer testing and AAS detection over the past 15 years.

Together, the studies aim to improve diagnostic pathways, inform future guidelines and enhance patient safety while reducing unnecessary testing.