POCUS Screening for TAA in Hypertensive Patients in the ED

Investigators trained with point-of-care ultrasound (POCUS) will recruit hypertensive patients in the emergency department (ED) of Prince of Wales Hospital. POCUS will be performed using a handheld ultrasound device to visualise the aortic root, ascending aorta, aortic arch and descending aorta. Measurements of the diameter will be obtained from different segments of the thoracic aorta for analysis. The definition of aortic aneurysm is a maximum aortic diameter of ≥ 4.5 cm and/or ≥ 50% localized enlarged diameter relative to the adjacent normal segment as indicated by POCUS. The primary outcome is the prevalence of thoracic aortic aneurysm (TAA) in hypertensive patients in the ED. The secondary outcomes include the number of patients with confirmed TAA as verified by CTA, BMI for all participants, the number of CTA scans conducted for TAA confirmation, the number of surgical interventions performed among TAA patients, the ICU admission rate, ICU length of stay, hospital length of stay and mortality, proportion of adequate visualisation of POCUS studies obtained, agreement of aortic diameter measurement between CTA and POCUS, and signs and symptoms of TAA patients presenting to the ED. In addition, the investigators will assess the 28-day all-cause mortality and any advanced imaging done outside the ED.

• Point-of-care ultrasound (Diagnostic test): POCUS screening will be conducted to measure the maximum diameters at end diastole of the aortic root, ascending aorta, aortic arch, and descending thoracic aorta.

Primary outcomes

• number of patients with a dilated aorta [Day 1]: is the number of patients with a maximum aortic diameter of ≥ 4.5 cm and/or ≥ 50% localized enlarged diameter relative to the adjacent normal segment as indicated by POCUS

Secondary outcomes

• number of patients with confirmed TAA [through study completion, an average of 1 year]: number of patients with confirmed TAA as verified by CTA

Other outcomes

• BMI for all participants [at the time of recruitment]: BMI in kg/m\^2
• number of CTA scans [through study completion, an average of 1 year]: number of CTA scans conducted for TAA confirmation
• number of surgical interventions [from recruitment to 28 days after]: number of surgical interventions performed among TAA patients
• ICU and hospital length of stay [through study completion, an average of 1 year]: ICU and hospital length of stay among patients with treatment for TAA
• mortality [from recruitment to 28 days after]: 28-day mortality in both TAA and non-TAA patients
• proportion of adequate visualisation of POCUS studies obtained [up to 1 year]: proportion of adequate visualisation of POCUS studies (%) obtained during the recruitment period
• agreement of aortic diameter measurement [from recruitment to 28 days after if CTA is performed]: agreement of aortic diameter measurement between CTA and POCUS in cm

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Adult patients aged ≥ 18 years attending the ED during the study period
* Known history of hypertension or newly diagnosed hypertension in the ED

Exclusion Criteria:

* Known history of aortic aneurysm or dissection
* Previous thoracic aortic interventions or endovascular stenting
* Patients in cardiopulmonary resuscitation
* Traumatic patients
* Patients refuse to participate the study

• Colin A Graham, Professor, Principal investigator, Accident and Emergency Medicine Academic Unit, CUHK