ADviSED - Aortic Dissection Detection Risk Score Plus D-Dimer for Aortic Syndromes

Rule out aortic dissection and other aortic syndromes

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1.Are you considering aortic dissection or acute aortic syndrome?
2.High Risk Condition?
3.High Risk Pain Features?
4.High Risk Exam Features?
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1. Are you considering aortic dissection or acute aortic syndrome?

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Should be considered in any patient with chest, back or abdominal pain, syncope or symptoms consistent with a perfusion defect (CNS, myocardial, mesenteric or limb ischemia)

Acute aortic syndromes include aortic dissection, intramural aortic hematoma, aortic rupture, and penetrating aortic ulcer.

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Acute aortic syndromes (AAS) include aortic dissection, intramural aortic hematoma, penetrating aortic ulcer, and aortic rupture. These diagnoses are uncommon, difficult to diagnose, and clinical suspicion can lead to complex and resource intensive testing.

Nazerian et al studied the combination of a using D-Dimer and Aortic Dissection Detection (ADD) risk score to rule out acute aortic syndromes.

This international, multi-center, prospective observational study (n =1850) included adults presenting acutely (within 14d) with ≥1 of the following: non-traumatic chest pain, abdominal pain, back pain, syncope, or perfusion deficit.

Patients were only considered for enrollment if the clinician considered an acute aortic syndrome as a potential diagnosis.

It was found that a negative D-Dimer (<500 ng/ml) and an Aortic Dissection Detection (ADD) risk score of ≤1 missed only 0.3% of patients with an acute aortic syndrome. Missed cases either had a widened mediastinum on chest x-ray or they presented with sudden, severe, ripping chest pain. This approach provided a sensitivity of 99.6% and negative predictive value of 99.7%.

This rule out strategy for acute aortic syndromes still requires external validation. Readers should decide whether it is appropriate for application in clinical practice.

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