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Introduction Aortic dissection (AD) represents a cardiovascular emergency with significant morbidity and mortality. While recent literature reports varying incidence rates of 4–7 among 100,000 people annually, the demographic patterns, diagnostic yield, and clinical outcomes in emergency department (ED) settings require further investigation. This study aims to provide comprehensive epidemiological data on patients undergoing CT angiography (CTA) for suspected aortic dissection in SVUH, a tertiary ED in Dublin.Methods Retrospectively, 922 aortic CTA studies from 2020–2024 were reviewed. Demographics, gender- and age-specific positive rates, annual trends, and incidental findings were analysed using descriptive statistics. Medians and interquartile ranges (IQR) are reported for continuous variables. A two-sample z-test compared gender positive rates.Results Out of 922 studies, 528 (57.3%) were male and 394 (42.7%) female. Median age was 66 years (IQR 54–77); males 64.5 (53–76), females 68 (56.25–78). Age distribution: <50 years 17.1%, 50–59 years 18.1%, 60–69 years 23.8%, 70–79 years 21.4%, and ≥80 years 19.6%. Overall, 63 positive cases were identified (6.8%). Rates did not differ by gender (males 6.63% vs females 7.11%, p=0.76) and varied minimally across age groups over 50: 50–59 years 7.8%, 60–69 years 5.9%, 70–79 years 7.1%, ≥80 years 7.7%. Median age for positive cases was 68 years. Incidental findings occurred in 54.2% of CTAs, most commonly aneurysms (n=103). Annual positivity declined from 10.2% in 2020 to 5.3% in 2022 before stabilising at 6.0–6.1% in 2023–2024.Conclusion A 6.8% positive yield aligns with literature (2%-8%). Male predominance in scan numbers did not translate to higher AD rates. High incidence of incidental findings highlights CTAs broader diagnostic value. Declining positivity likely reflects greater clinical vigilance but also highlights the need for standardised imaging protocols and care pathways. Future studies should evaluate how implemented pathways affect rates of missed or delayed AD diagnoses for further optimized ED diagnostic yield. *presenting author