Calc Function

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    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
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    Aortic Dissection Detection Risk Score (ADD-RS)

    Rules out aortic dissection.
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    IMPORTANT

    ADD-RS + D-dimer (the ADvISED study algorithm) has not been externally validated in ruling out acute aortic dissection and should thus be used with caution. The ADD-RS itself is validated.

    When to Use
    Pearls/Pitfalls
    Why Use

    Low to moderate risk patients for whom acute aortic syndromes (AAS) are in the differential diagnosis.

    • The Aortic Dissection Detection Risk Score (ADD-RS) in combination with D-dimer has been proposed and internally validated as a diagnostic algorithm. There are significant caveats:
      • Algorithm has not been externally validated.
      • Half of the patients in the study did not get definitive imaging and follow up was only 14 days, raising the question of possible missed cases.
      • The American College of Emergency Physicians’ (ACEP) 2014 Clinical Policy advises against using D-dimer alone to rule out AAS, though based on Level C evidence.
      • ADD-RS and D-dimer are not meant to diagnose AAS, but rather, to provide guidance in risk stratification for who merits imaging.
    • Consider using this risk stratification algorithm in patients considered low risk for aortic dissection but with uncertainty that the diagnosis can be ruled out.
    • ADD-RS scores range from 0-3, as patients can only get one point from each category (predisposing conditions, pain features, exam findings). Thus, the score does not account for a patient that may have 2 points in a given category. Patients with multiple points in a given category may not be appropriate for the algorithm.
    • May reduce misdiagnosis of AAS.
    • May reduce over-testing for AAS (avoiding radiation and cost associated with definitive imaging).
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    • For ADD-RS >1, consider proceeding directly to CTA or other conclusive imaging.
    • For ADD-RS ≤1, proceed to D-dimer testing. If dimer <500 ng/mL, consider stopping workup of dissection; if ≥500 ng/mL, consider CTA.

    Critical Actions

    • Use in conjunction with other diagnostics to address other emergent, more common causes of chest pain.
    • In patients with high pretest probability of AAS, consider empirically treating hypertension/tachycardia if there is any delay in getting conclusive imaging.
    Content Contributors
    • Seth Crockford, MD
    About the Creator
    Dr. Peiman Nazerian
    Are you Dr. Peiman Nazerian?
    Content Contributors
    • Seth Crockford, MD