We appreciate the comments and the interesting case series
described by Drs. Schena, Agnino, and Schinosa in response to our
recent report.1 In their series, 154 of 176 patients
(88%) with aortic dissection had severe chest pain, while the
remaining 22 patients had other symptoms, so that technology played an
even more critical role in diagnosis. They conclude that the diagnosis
requires “interaction between physicians and machines.” We agree.
Our point is that a careful, not lengthy, history is what enables the
clinician first to consider and then to order the appropriate test in
this catastrophic disorder. Their large series corroborates our finding
that the initial history is useful in the vast majority of patients.
Even in patients in whom the symptoms were not striking, it was still
the history that guided the clinician to the appropriate, often
lifesaving, diagnostic test and treatment. We all agree that both
physicians and machines are essential in every case for rapid diagnosis
of aortic dissection.