The DAShED (Diagnosis of Acute Aortic Syndrome in the ED) study: An observational cohort study of people attending the ED with symptoms consistent of Acute Aortic syndrome (AAS)

Acute aortic syndrome (AAS) is a life-threatening emergency condition affecting the upper aorta affecting ~4000 people in the UK a year with an ED misdiagnosis rate as high as 38%.

Previous research has identified several strategies combining clinical probability scoring with blood tests (D-Dimer) to rule out the condition but when applied to a large population (ED) with relatively low numbers of actual cases, these result in a high rate of computed tomographic angiography (CTA) scanning. Current guidelines reflect the uncertainty of existing evidence.

This study, the first phase of three, aims to describe the characteristics of ED attendances with possible AAS, to determine the service implications of using different diagnostic strategies and inform future research

We plan to recruit all ED attendances with possible AAS over a 1-4 week period. We plan a prospective and retrospective approach to data collection adopting a waived-consent strategy with endpoint measures describing the characteristics of patients presenting with possible AAS.

We were delighted to learn in April 2022, that DAShED received funding from RCEM.

The study completed in December 2022 and is currently under review with the Emergency Medicine Journal. The study results will be presented at the RCEM Annual Scientific Conference; 26-28 September 2023.

Ethics approved study paperwork:

Protocol 2.0

Patient Information Sheet


eCRF – Training Redcap database

Paper CRF


SIV slides

SIV video

PI Investigator meeting 8th August (click here to view)

Delegation log and Training record

DAShED Site Signature & Delegation Log v1.0_12082022

DAShED Study specific Training Record v1_12082022

Clinician poster for EDs (not for patient areas)

Clinician poster

DAShED Study Data Sharing Plan

Data Sharing Plan

Related published work:

McLatchie R, Wilson S, Reed MJ, Ticehurst F, Easterford K, Alawiye S, Cowan A, Gupta A, on behalf of the Aortic Dissection Diagnosis Research Group. Why do Emergency Department Clinicians Miss Acute Aortic Syndrome? A Case Series and Descriptive Analysis. ECJ 2023; 19: 11153; https://doi.org/10.4081/ecj.2023.11153

McLatchie R, Aakash Gupta A, Wilson S, Reed MJ on behalf of the Aortic Dissection Diagnosis Research Group. A sinister needle in an enormous haystack: A clinician survey regarding Acute Aortic Syndrome (AAS) diagnostic practice in United Kingdom Emergency Department Emergency Care Journal 2022; volume 18:10758; https://www.pagepressjournals.org/index.php/ecj/article/view/10758/10550

Scottish RCEM Conference: Acute aortic syndrome Clinician Survey abstract

Scottish RCEM Conference: Acute Aortic Syndrome (AAS) in NHS Lothian: a local retrospective case note review abstract

Scottish RCEM Conference: Acute Aortic Syndrome (AAS) in NHS Lothian: a local retrospective case note review slideshow

Scottish RCEM Conference 2022: Building a research case for better Acute Aortic Syndrome diagnosis slideshow; Matt Reed; RCEM Professor; Rachel McLatchie; ST5 EM trainee


Status: closed

Start Date

June 2022

Chief Investigator

Dr Rachel McLatchie / Prof Matt Reed

Coordinated by

Nicky Freeman

Main Trial Site

Royal Infirmary of Edinburgh

End date

December 2022