Aortic_Dissection_Detection_Risk_Score_guideline v.1
Formula: Addition of the selected points as below: Any high risk condition=Marfan syndrome, Family history of aortic disease, Known aortic valve disease, Recent aortic manipulation, Known thoracic aortic aneurysm= 1 point Any high risk pain feature=Chest, back, or abdominal pain described as any of the following: Abrupt onset, Severe intensity, Ripping or tearing=1 point Any high risk exam feature= Evidence of perfusion deficit (pulse deficit, systolic BP differential, or focal neurological deficit in conjunction with pain), New murmur of aortic insufficiency (with pain), Hypotension or shock state= 1 point Interpretation based on the ADD-RS: ADD-RS≤1=Proceed to D-dimer testing. If dimer <500 ng/mL, consider stopping workup of dissection, if ≥500 ng/ml, consider CTA. ADD-RS>1=Consider proceeding directly to CTA or other conclusive imaging
Aortic dissection detection risk score (ADD-RS) is allowing a standardized assessment of the pre-test probability of Acute aortic syndromes (AAS).
ADD-RS can be used in patients aged >18 years.
Aortic dissection detection risk score (ADD-RS) cannot be used in patients with primary trauma and unwillingness.
Nazerian, P., Mueller, C., Soeiro, A. M., Leidel, B. A., Salvadeo, S., Giachino, F., Vanni, S., Grimm, K., Oliveira, M. T., Jr, Pivetta, E., Lupia, E., Grifoni, S., Morello, F., ADvISED Investigators (2018). Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study. Circulation, 137(3), 250–258. https://doi.org/10.1161/CIRCULATIONAHA.117.029457. Rogers, A. M., Hermann, L. K., Booher, A. M., Nienaber, C. A., Williams, D. M., Kazerooni, E. A., ... and Harris, K. M. (2011). Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection. Circulation, 123(20), 2213-2218. Hiratzka, L. F., Bakris, G. L., Beckman, J. A., Bersin, R. M., Carr, V. F., Casey, D. E., ... and Kouchoukos, N. T. (2010). 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Journal of the American College of Cardiology, 55(14), e27-e129. Diercks, D. B., Promes, S. B., Schuur, J. D., Shah, K., Valente, J. H., and Cantrill, S. V. (2015). Clinical policy: critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. Ann Emerg Med, 65(1), 32-42.
OBSERVATION.aortic_dissection_detection_risk_score_add_rs.v0
