MDCalc

Aortic Dissection Detection Risk Score (ADD-RS)

Rules out aortic dissection.

This tool assumes lab reporting of d-dimer in fibrinogen equivalent units (FEU). Know how your institution reports d-dimer levels and adjust accordingly. 

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.

Any high risk condition
Marfan syndrome, family history of aortic disease, known aortic valve disease, recent aortic manipulation, or known
Any high risk pain feature
Chest, back, or abdominal pain described as abrupt onset, severe intensity, or ripping/tearing
Any high risk exam feature
Evidence of perfusion deficit (pulse deficit, systolic BP differential, or focal neuro deficit plus pain), new aortic insufficiency murmur (with pain), hypotension/shock

Result:

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Advice
  • This study D-dimer threshold assumes D-dimer is reported in fibrinogen equivalent units (FEU). If your institution utilizes D-dimer units (DDU) to report D-dimer levels, please convert accordingly.
  • More information on D-dimer use in the emergency department can be found in this ACEP Clinical Policy.
Management
  • For ADD-RS >1, consider proceeding directly to CTA or other conclusive imaging.
  • For ADD-RS ≤1, proceed to D-dimer testing. If D-dimer FEU <500 ng/mL, consider stopping workup of dissection; if D-dimer FEU ≥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.
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