Original research
Fletcher, Lianne Wright, Lucy-May Moulden, Tom Ward, Andrew Tabner, Sarah Allen, Hannah Phillips, Obiageli Ngwuocha (University Hospitals of Derby and Burton NHS Foundation Trust, UK); Larisa Chirila, Hannah Britton, Julimon Sebastian, John Obiakor, Nathan Hancock (Kettering General Hospital, Northamptonshire, UK). Contributors RM, MJR, NF, RAP, SW, SG, AC, JB, BC and EC conceived the study and were involved in study design and study delivery. MJR and RAP performed data analysis. RM, MJR, NF, RAP, SW, SG, AC, JB, BC and EC were involved in data interpretation and RM, MJR, NF, RAP, SW, SG, AC and EC prepared the manuscript. RM, MJR, NF, RAP, SW, SG, AC, JB, BC and EC contributed to its revision. MJR takes responsibility for the paper as a whole and acts as guarantor, accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. The DAShED investigators were involved in the acquisition of data for the work. Funding This study was supported by a Royal College of Emergency Medicine (RCEM) research grant. MJR is supported by an NHS Research Scotland Career Researcher Clinician award. Competing interests None declared. Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details. Patient consent for publication Not applicable. Ethics approval The study was approved by the South-Central Oxford C Research Ethics Committee on 28 June 2022 (REC reference: 22/SC/0219). A waived consent process was approved by the Ethics Committee and by HRA. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available upon reasonable request. All study data and metadata will be available upon reasonable request to dashedstudy@g mail.com. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. ORCID iDs REFERENCES 1 Rotella JA, Yeoh M. Taming the zebra: unravelling the barriers to diagnosing aortic dissection. Emerg Med Australas 2018;30:119–21. 2 Research priorities for Acute Aortic Dissection. DHSC research workshop summary NOTE. Available: https://www.england.nhs.uk/north-west/wp-content/uploads/sites/ 48/2020/02/hsib-report-delayed-recognition-acute-aortic-dissection.pdf [Accessed 08 Mar 2023]. 3 Hiratzka LF, Bakris GL, Beckman JA, et al . ACCF/ AHA/ AATS/ ACR/ ASA/ SCA/ SCAI/ SIR/ STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. J Am Coll Cardiol 2010;55:e27–129. 4 Howard DPJ, Banerjee A, Fairhead JF, et al . Population-based study of incidence and outcome of acute aortic dissection and pre-morbid risk-factor control: 10-year results from the Oxford vascular study. Circulation 2013;127:2031–7. 5 Smedberg C, Steuer J, Leander K, et al . Sex differences and temporal trends in aortic dissection: a population-based study of incidence, treatment strategies, and outcome in Swedish patients during 15 years. Eur Heart J 2020;41:2430–8. 6 DeMartino RR, Sen I, Huang Y, et al . Population-based assessment of the incidence of aortic dissection, intramural hematoma, and penetrating ulcer, and its associated mortality from 1995 to 2015. Circ Cardiovasc Qual Outcomes 2018;11:e004689. 7 Lovatt S, Wong CW, Schwarz K, et al . Misdiagnosis of aortic dissection: a systematic review of the literature. Am J Emerg Med 2022;53:16–22. 8 Harris KM, Nienaber CA, Peterson MD, et al . Early mortality in type a acute aortic dissection: insights from the international registry of acute aortic dissection. JAMA Cardiol 2022;7:1009–15. 9 Erbel R, Aboyans V, Boileau C, et al . ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic Rachel McLatchie http://orcid.org/0000-0002-0863-1929 Matthew J Reed http://orcid.org/0000-0003-1308-4824 Sarah Wilson http://orcid.org/0000-0003-3964-0809 Steve Goodacre http://orcid.org/0000-0003-0803-8444
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