Type B Aortic Dissection Management Strategies: National Survey, Systematic Review, and Pooled Clinician Perceptions

Background: Type B aortic dissection management relies on risk stratification, yet evidence-based tool adoption remains inconsistent in NHS. Bridging the gap between Emergency Medicine and Vascular Surgery remains essential for timely diagnosis, optimal risk stratification, and appropriate intervention to improved outcomes and reduced mortality. Methods: A cross-sectional survey of EM consultants yielded n=173 valid responses from n=33 units across UK. Subgroup analyses was conducted using a Chi-square test (p < 0.05) alongside descriptive analysis. A pooled prevalence analysis of the literature, utilizing a random-effects model at a 95% confidence interval (CI), served as a benchmark for perception analysis. Agreement was evaluated using Bland-Altman analysis, incorporating upper, lower, and overall bias of agreeability. Results: Access to rapid CTA was 70% (95% CI: 63.3%–76.8%, p < 0.001), while 32% had SOPs for TBAD (95% CI: 25.3%–39.1%), and 26% were aware of any decision tool (95% CI: 20.6%–33.6%). Labetalol as a first-line antihypertensive was more common amongst least experience (p < 0.05). TBAD diagnosis increased 1.6-fold with every 4 years of additional experience (p < 0.05). Perception analysis showed strong agreement for pain (characteristics and location), hypertension, gender, and age with moderate-to-low agreement for other factors with reported bias of bias of 23.58% (-38.20% to 85.36%) (p = 0.02). Results: The survey suggests a degree of misperception and inconsistency in recognition of most and least prevalence factors for TBAD suspicion and management. This outcome advocates targeted strategies to enhance diagnostic accuracy using tools aligned with NHS resources and QALY frameworks.