Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute aortic dissection.
BACKGROUND
Acute aortic dissection (AD) represents a diagnostic conundrum. Validated algorithms are particularly needed to identify patients where AD could be ruled out without aortic imaging. We evaluated the diagnostic accuracy of a strategy combining the aortic dissection detection (ADD) risk score with D-dimer, a sensitive biomarker of AD.


METHODS
Patients from two clinical centers with suspected AD were prospectively enrolled in a registry, from January 2008 to March 2013. The ADD risk score was calculated by retrospective blinded chart review. For D-dimer, a cutoff of 500 ng/ml was applied.


RESULTS
AD was diagnosed in 233 of 1035 (22.5%) patients. The ADD risk score was 0 in 322 (31.1%), 1 in 508 (49.1%) and >1 in 205 (19.8%) patients. The sensitivity and the failure rate of D-dimer were 100% and 0% in patients with ADD score 0, versus 97.5% (95% CI 91.4-99.6%) and 4.2% (95% CI 0.7-12.5%) in patients with ADD risk score >1. In patients with ADD risk score ≤ 1, the sensitivity and the failure rate of D-dimer were 98.7% (95% CI 95.3-99.8%) and 0.8% (95% CI 0.1-2.6%). The diagnostic efficiency of D-dimer in patients with ADD risk score 0 and ≤ 1 was 8.9% (95% CI 7.2-10.7%) and 23.6% (95% CI 21.1-26.2%) respectively.


CONCLUSIONS
In a large cohort of patients with suspected AD, the presence of ADD risk score 0 or ≤ 1 combined with a negative D-dimer accurately and efficiently ruled out AD.
Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
Peiman
P
Nazerian
Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy. Electronic address: fmorello@cittadellasalute.to.it.
Fulvio
F
Morello
Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
Simone
S
Vanni
Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy.
Alessia
A
Bono
Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
Matteo
M
Castelli
Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy.
Daniela
D
Forno
Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
Chiara
C
Gigli
Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy.
Flavia
F
Soardo
Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy.
Federica
F
Carbone
Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy.
Enrico
E
Lupia
Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
Stefano
S
Grifoni
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000097:blood* / Q000175:diagnosis*; D001014:Aortic Aneurysm / Q000097:blood* / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016037:Single-Blind Method
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
Aortic dissection; D-dimer; Diagnosis