Aortic dissection detection risk score

The aortic dissection detection risk score (ADD-RS) is a clinical decision tool that aids in grading the pretest probability of an acute aortic dissection. Scores range from 0-3, where 0 is classed as low risk, 1 is moderate risk and 2-3 is high risk ¹.

Criteria

The three domains in which patients may score a point are:

High-risk conditions

One point for any of the following to a maximum of 1:

• Marfan’s syndrome, Loeys-Dietz syndrome, vascular Ehlers-Danlos syndrome, Turner’s syndrome or other connective tissue diseases
• other predisposing genetic mutations, e.g. FBN1, TGFBR1
• family history of aortic dissection
• known aortic valve disease
• recent aortic manipulation
• known thoracic aortic aneurysm

High-risk pain features

One point for any of the following to a maximum of 1:

• pain in the chest, back or abdomen that is
  • sudden onset
  • severe in intensity
  • ripping, tearing or sharp quality

High-risk examination findings

One point for any of the following to a maximum of 1:

• pulse deficit
• systolic blood pressure limb difference (>20 mmHg)
• focal neurological deficit
• new aortic murmur of aortic regurgitation

Interpretation

A low-risk ADD score by itself, or when combined with a non-widened mediastinum (normal limits vary per projection, FFD and x-ray cassette positioning ⁶) on chest x-ray, makes the diagnosis of dissection unlikely. However, it cannot confidently rule it out and negate the need for further imaging ^2,3. The aortic dissection detection risk score plus d-dimer for aortic syndrome has offered a more reliable method to rule out acute aortic syndrome ^4,5.