The use of the aortic dissection detection risk score plus d-dimer is a proposed standardised strategy of safely ruling out the diagnosis of an acute aortic syndrome. Similar to how the pulmonary embolism rule-out criteria (PERC) negates the need for further workup of a pulmonary embolism.
- patients with an ADD-RS score >1 should proceed directly to imaging regardless of the d-dimer result
- patients with ADD-RS of 0 or 1 with a positive d-dimer (>500 ng/mL) should proceed to further imaging
- in patients with ADD-RS of 0 or 1 with a negative d-dimer (<500 ng/mL) the diagnosis of an acute aortic syndrome can be excluded
This strategy was found to miss approximately 1/300 cases of acute aortic syndromes but also may reduce the rates of imaging by up to a half. The use of this algorithm has not been prospectively tested or widely implemented in clinical practice and care should be taken whilst using it.
- 1. Nazerian P, Mueller C, Soeiro AM, Leidel BA, Salvadeo SAT, Giachino F, Vanni S, Grimm K, Oliveira MT, Pivetta E, Lupia E, Grifoni S, Morello F. Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study. (2018) Circulation. 137 (3): 250-258. doi:10.1161/CIRCULATIONAHA.117.029457 - Pubmed
- 2. Nazerian P, Morello F, Vanni S, Bono A, Castelli M, Forno D, Gigli C, Soardo F, Carbone F, Lupia E, Grifoni S. Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute aortic dissection. (2014) International journal of cardiology. 175 (1): 78-82. doi:10.1016/j.ijcard.2014.04.257 - Pubmed
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