D-Dimer Combined with a Risk Score to Rule Out Aortic Dissection

Aortic dissection and other acute aortic syndromes (AASs), if missed, result in high mortality. Because symptoms are common and can be nonspecific, it's not possible to perform computed tomography-angiography in all patients. Unfortunately, D-dimer by itself is not sufficiently sensitive to exclude AASs in patients with high clinical suspicion.

The aortic dissection detection risk score (ADD-RS) assigns 1 point for presence of one or more high-risk features in each of three categories: predisposing conditions, pain type, and physical exam (score ranges from 0–3). These authors conducted a systematic review to test whether D-dimer combined with the ADD-RS could exclude AAS. They tested four strategies, using combinations of ADD-RS thresholds …