Non-surgical strategies to improve timely recognition and management of patients with ruptured abdominal aortic aneurysm across prehospital and hospital settings—a scoping review

Background: Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition with high prehospital mortality. Early recognition and timely management—particularly before surgery—are critical to improve survival. However, the patient journey from symptom onset to surgical intervention involves complex logistics across multiple healthcare providers. This scoping review aimed to identify and summarize non-surgical strategies to improve timely recognition and management of rAAA across prehospital and hospital settings. Methods: We conducted a scoping review of studies reporting interventions targeting the interval between symptom onset and surgical intervention in patients with rAAA. Additionally, we included studies examining factors associated with delayed or missed diagnosis. Observational studies with control or comparison groups were eligible. We searched MEDLINE for studies published before September 26, 2024 (last update) and performed snowballing for additional references. Results: Six observational studies evaluated system-level strategies, including regional centralization and multidisciplinary care protocols. Although five reported improved survival, all had serious methodological limitations and a high risk of bias. No randomized controlled trials or studies specifically targeting the prehospital diagnostic phase were identified. Five additional studies addressed factors associated with delayed diagnosis, with signs of hemodynamic instability linked to more timely recognition. Two further studies identified through snowballing contributed relevant insights: one found that patients residing more than one hour from a vascular center had higher mortality, and another demonstrated that a Shock Index ≥1.0 at presentation was associated with significantly increased in-hospital mortality, highlighting the prognostic potential of simple early triage tools.Conclusions: There is a striking lack of high-quality evidence on early recognition and timely management of rAAA, especially in the prehospital setting. While regionalization may offer survival benefits, current evidence is limited by confounding and other biases. Future research should prioritize prospective studies of prehospital diagnostic tools, structured triage protocols, and access to specialized vascular care— particularly for patients in rural or remote areas.