Clinical question: Can the aortic dissection detection (ADD) risk score be used to screen patients for acute aortic dissection at the bedside?
Background: AAD, a life-threatening condition, often is missed due to relatively low incidence, varied presentation, and need for advanced imaging studies. The American Heart Association and the American College of Cardiology have published guidelines on thoracic aortic disease from which the ADD risk score has been adapted to identify high-risk patients and to suggest additional testing based on pretest probability of disease.
Study design: Retrospective application of ADD risk score to the International Registry of Acute Aortic Dissection (IRAD) database.
Setting: Multinational medical registry compiled from 24 medical centers.
Synopsis: A total of 2,538 patients with confirmed ADD were reviewed. The number of patients presenting with one or more of 12 proposed clinical risk markers was determined. An ADD risk score of 0 to 3 was calculated based on the number of risk categories (high-risk predisposing conditions, pain features, examination features) in which patients met criteria.
Among 108 (4.3%) patients found to be low-risk (ADD score 0), 72 had a chest X-ray, 35 of which were found to have a widened mediastinum. High-risk features (ADD score 2 or 3) were found in 1,503 (59.2%) patients, and the remaining 927 (36.5%) patients had intermediate risk (ADD score 1).
The guidelines recommend further imaging for all intermediate- and high-risk patients and for low-risk patients with a wide mediastinum resulting in very good sensitivity.
Bottom line: The ADD risk score is a sensitive bedside screening tool for aortic dissection, ensuring that more than 95% patients with true dissection undergo further investigation, but it may lead to overinvestigation due to unknown specificity.
Citation: Rogers AM, Hermann LK, Booher AM, et al. 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. Circ. 2011;123:2213-2218.
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