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Aortic Dissection Detection Risk Score – Is It Clinically Useful?

June 24, 2020

Written by Clay Smith

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The aortic dissection detection risk score (ADD-RS) is sensitive using a score of ≥1. Adding a D-dimer to the score improves sensitivity even more but at the cost of a slightly lower specificity.

Why does this matter?
Aortic dissection is a “can’t miss” diagnosis. But it is also bad stewardship to scan every person who complains of chest or abdominal pain. Is there a way to decide when to scan or not?

There is always a cost
This was a brief synopsis of a systematic review published elsewhere*. This was a systematic review of 9 studies, 8 of which were retrospective. They found the sensitivity of an ADD-RS ≥1 was 94%; specificity 40%. Just to be clear, this means a score of zero. Adding a D-dimer in addition to a ADD-RS ≥2* improved sensitivity to 99% but dropped specificity to 35%. See Table. Here is my take home. If you practice in a location with a low prevalence of aortic dissection and have a negative ADD-RS and D-dimer, you can stop and not perform CTA. Of course, you still need to workup other etiologies of chest or abdominal pain as usual, but it is very unlikely the pain is due to dissection.

*Amended 6/24/20

From cited article

Source
What Is the Accuracy of the Aortic Dissection Detection Risk Score? Ann Emerg Med. 2020 May 14;S0196-0644(20)30255-9. doi: 10.1016/j.annemergmed.2020.04.005. Online ahead of print.

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*This Annals of EM Systematic Review Snapshot was a brief synopsis of this original article.
Tsutsumi Y, Tsujimoto Y, Takahashi S, et al. Accuracy of aortic dissection detection risk score alone or with D-dimer: a systematic review and metaanalysis. Eur Heart J Acute Cardiovasc Care. 2020; https:// doi.org/10.1177/2048872620901831.

3 thoughts on “Aortic Dissection Detection Risk Score – Is It Clinically Useful?

  • I think you mis-stated it or misread it. The 99%SN/35%SP is for ADD-RS of >/=2 + D-dimer. So you can have a ADD of 1 and negative D-dimer and still be ok with 99% sensitivity (97-1).

    Adding the d-dimer lets you go to a higher ADD score. If you do the ADD >/=1 and dimer the specificity is 15% not 35%

    • Oh man… You are right. The post is now amended to reflect this change. Thank you. I misread it. Thanks for catching this error.

  • Just to be clear – doesn’t an ADD-RS of >/= 1 mean the score is ‘not’ zero?

    And therefore, if ADD </=1 and negative D-dimer then no need for CTA.

What are your thoughts?