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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Aortic Dissection Detection Risk Score (ADD-RS)

    Rules out aortic dissection.

    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
    Dr. Peiman Nazerian

    About the Creator

    Peiman Nazerian, MD, is an internist in the emergency department at the Careggi University Hospital in Florence, Italy. He is an instructor in emergency ultrasound and has taught multiple courses in Italy and internationally. Dr. Nazerian's primary research interests are in pulmonary embolism and aortic dissection in the emergency setting.

    To view Dr. Peiman Nazerian's publications, visit PubMed

    Are you Dr. Peiman Nazerian? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Seth Crockford, MD
    About the Creator
    Dr. Peiman Nazerian
    Are you Dr. Peiman Nazerian?
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