Aortic Dissection Detection Risk Score: A Clinical Decision Rule That Needs Some Parenting

Hill, Jeffery; Murphy, Timothy G; Fermann, Gregory J.

doi:10.1111/acem.13636

Cited by 7 publications

(2 citation statements)

References 11 publications

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“…In this context, it must also be mentioned that this would produce many patients as false positives and expose them to radiological overtesting. 24 One reason for this is the low specificity, especially for a score of ADDRS⩾1, which ranges between 26.4–64.6%. 21 –23 Furthermore, a low positive predictive value for an ADDRS ⩾1, as in Nazerian et al of only 39%, leads to a significant expansion of the diagnostic workup in many emergency room patients with suspected aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care – surgical delay because of initial misdiagnosis

Zaschke

Habazettl

Thurau

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background: Acute type A aortic dissection requires immediate surgical treatment, but the correct diagnosis is often delayed. This study aimed to analyse how initial misdiagnosis affected the time intervals before surgical treatment, symptoms associated with correct or incorrect initial diagnosis and the potential of the Aortic Dissection Detection Risk Score to improve the sensitivity of initial diagnosis. Methods: We conducted a retrospective analysis of 350 patients with acute type A aortic dissection. Patients were divided into two groups: initial misdiagnosis (group 0) and correct initial diagnosis of acute type A aortic dissection (group 1). Symptoms were analysed as predictors for the correct or incorrect initial diagnosis by multivariate analysis. Based on these findings, the Aortic Dissection Detection Risk Score was calculated retrospectively; a result ⩾2 was defined as a positive score. Results: The early suspicion of aortic dissection significantly shortened the median time from pain to surgical correction from 8.6 h in patients with an initial misdiagnosis to 5.5 h in patients with the correct initial diagnosis ( p<0.001). Of all acute type A aortic dissection patients, 49% had a positive Aortic Dissection Detection Risk Score. Of all initial misdiagnosed patients, 41% had a positive score (⩾2). The presence of lumbar pain ( p<0.001), any paresis ( p=0.037) and sweating ( p=0.042) was more likely to lead to the correct initial diagnosis. Conclusion: An early consideration of acute aortic dissection may reduce the delay of surgical care. The suggested Aortic Dissection Detection Risk Score may be a useful tool to improve the preclinical assessment.

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Section: Discussionmentioning

confidence: 99%

Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care – surgical delay because of initial misdiagnosis

Zaschke

Habazettl

Thurau

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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“…First, ADD‐RS, a decision rule derived from a retrospective register of AASs, has low specificity 37 . In addition, ADD‐RS derivation methods have not been published, and it is currently unknown whether use of the ADD‐RS provides any advantage in terms of diagnostic accuracy and of CTA ordering, compared to clinical gestalt 39,40 . In the future, focused ED‐centered studies may provide alternative and more specific probability assessment tools.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Aortic Dissection Detection Risk Score Plus D‐dimer for Diagnostic Rule‐out Of Suspected Acute Aortic Syndromes

Bima

Pivetta

Nazerian

et al. 2020

Academic Emergency Medicine

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Objectives: In patients at low clinical probability of acute aortic syndromes (AASs), decision on advanced aortic imaging is cumbersome. Integration of the aortic dissection detection risk score (ADD-RS) with D-dimer (DD) provides a potential pipeline for standardized diagnostic rule-out. We systematically reviewed and summarized supporting data. Methods: Cross-sectional studies assessing integration of ADD-RS with DD for diagnosis of AASs were identified on MEDLINE, EMBASE and Web Of Science databases. Two reviewers independently screened articles, assessed quality, and extracted data. The quality of design and reporting was evaluated with the QUADAS-2 and STARD tools. Individual patient data were obtained, to allow analysis of both conventional (500 ng/mL) and age-adjusted (DD age-adj) DD cutoffs. Data were summarized for four diagnostic strategies combining ADD-RS = 0 or ≤ 1, with DD < 500 ng/mL or < DD age-adj. The statistical heterogeneity of the diagnostic variables was estimated with Higgins' I 2. Pooled values were calculated for variables showing nonsignificant heterogeneity. Results: After screening of 680 studies, four articles (including a total of 3,804 patients) met inclusion criteria. One prospective study provided a low risk of bias/applicability concerns, while methodologic limitations were found in the other three retrospective studies. Statistical heterogeneity was negligible for sensitivity and negative likelihood ratio (LR) values and significant for specificity and positive LR values of all diagnostic strategies. Pooled sensitivity was 99.

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Aortic Emergencies

Raja

Pines

2023

Evidence‐Based Emergency Care

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Aortic Dissection Detection Risk Score: A Clinical Decision Rule That Needs Some Parenting

Cited by 7 publications

References 11 publications

Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care – surgical delay because of initial misdiagnosis

Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care – surgical delay because of initial misdiagnosis

Systematic Review of Aortic Dissection Detection Risk Score Plus D‐dimer for Diagnostic Rule‐out Of Suspected Acute Aortic Syndromes

Aortic Emergencies

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