Aortic dissection is an uncommon diagnosis in the Emergency Department (ED), with a prevalence of 2.5 to 3.5 cases per 100,000 patient-years, and a high patient mortality of 1–2 % per hour [[1], [2], [3]]. The diagnosis can be difficult to make, as the symptoms are often vague, however, patients often present with chest pain accompanied by other symptoms such as back pain, abdominal pain, or neurologic symptoms [[4], [5], [6]]. Depending on where the dissection is within the aorta, a dissection can be classified as Stanford type A if it involves the ascending aorta proximal to the brachiocephalic artery, or Stanford type B if the dissection is distal to the brachiocephalic artery or within the descending aorta [4]. A definitive diagnosis of aortic dissection is made with a computed tomography angiography (CTA) of the chest, abdomen, and pelvis [5].

Point-of-care ultrasound (POCUS) has been shown in previous studies to improve the diagnosis of aortic dissection, as it is often associated with dilation of the aortic outflow tract (AOFT) to >4.0 cm [1,3,[7], [8], [9], [10]]. While the aorta can dissect when the AOFT measures <3.5 cm, previous research has shown an increased prevalence when the AOFT measures >4.0 cm [1,3,11]. An outer-to-inner measurement (leading edge) has been shown to better correlate to aortic measurements on CTA compared to measuring inner-to-inner [12].

Studies also show that POCUS decreases door to CTA time and time to diagnosis [1,9,13]. A metanalysis published by Mani et al. on aortic dissection diagnosis with ultrasound included 16 studies and four studies used thoracic aneurysm diagnosis as an indirect marker for aortic dissection with a pooled sensitivity and specificity of 92 % and 87 % [14]. These studies show that POCUS can help diagnose aortic dissection, but given the rarity of the diagnosis the studies are limited by sample size or inclusion of non-dissection aortic syndromes.

The aim of our study was to determine the association of AOFT diameter measured by POCUS with diagnosis of both Stanford type A and type B dissections, along with determining the time to POCUS, and the time to CTA and its relationship with POCUS.