Aortic dissection detection risk score

Last revised by Rohit Sharma on 26 Jun 2018

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.


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


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.

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