D-dimer for dissection?

    NextPrevious

    D-dimer for dissection?

    Aortic dissection continues to be one of the most difficult diagnoses to make. The IRAD study from 2009 found that a d-dimer <500 ng/mL used to rule out acute aortic dissection had a negative likelihood ratio of 0.07 in the first 24 hours, with a sensitivity of 96.6%. Check out the study here.  In terms of decision tools, the Aortic Dissection Detection Risk Score (ADD-RS) is a validated clinical tool to help risk stratify low to moderate risk patients. Read about the ADD-RS here.

    One study, the ADvISED Trial, combined the use of d-dimer AND ADD-RS and, though not externally validated yet, showed some promising results. D dimer of <500ng/mL had sensitivity of 100% in ruling out dissection in patients with ADD-RS risk score of 0. Ultimately, ADD-RS risk score 0/≤1 plus d-dimer of <500 ng/mL accurately ruled out aortic dissection. Read the ADvISED Trial here.

    Consider using one of these tools (or both with caution) with your next low to moderate risk patient! Make it even easier and check out MdCalc.

    All the studies:

    Nazerian, Peiman, et al. “Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes: the ADvISED Prospective Multicenter Study.” Circulation (2017): CIRCULATIONAHA-117.

    Rogers, Adam M., et al. “Sensitivity of the Aortic Dissection Detection Risk Score, a Novel Guideline-Based Tool for Identification of Acute Aortic Dissection at Initial PresentationClinical Perspective: Results From the International Registry of Acute Aortic Dissection.” Circulation123.20 (2011): 2213-2218.

    Suzuki, Toru, et al. “Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience.” Circulation119.20 (2009): 2702-2707.

     

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • Bag Mask Ventilation During Intubation

      A few days ago NEJM published the results of an investigation with profound implications for our specialty.  A group of intensivists and anesthesiologists conducted a multicenter, randomized trial conducted in seven ICUs to study theRead more

    • Gastric Emptying for Acute Poisonings

      At the request of department leadership, we will be revisiting methods of gastric decontamination for today’s pearl.  Two methods in particular. Ipecac-induced emesis and gastric lavage are two procedures that we read about in medicalRead more

    • Pacemakers Review pt. 3

      Today we will review complications associated w/ implanted pacemakers that you may encounter in the ED and thus ought to be familiar with. Generally, complications can be divided into two categories: early vs. late EarlyRead more

    • Pacemakers Review Pt. 2

      Cardiac pacing as an intervention can be conceptualized as addressing problems in electrophysiological conduction and/or.  So, for example, if there is a disruption in the electrical continuity between the atrium and the ventricle, a pacerRead more

    • Pacemakers Review Pt. 1

      The pursuit of mastery over cardiovascular emergencies demands a rough familiarity with implanted devices which includes why they get implanted in the first place (indications), how they work, how they malfunction, and how they affectRead more

    • In honor of a rosh review question that I got wrong, lets review Lyme disease!   Lyme disease is caused by the spirochete Boriella burgdorferi, transmitted to humans through tick bites from ixodes ticks. Location:Read more

    • NGT INSERTION

      Your patient has an SBO and has repeated bilious emesis on the side. The surgery team is in the OR and they ask if you can place the nasogastric tube (NGT). Lets review proper NGTRead more

    • No, that’s not an olive. That’s Pyloric Stenosis!

      Inspired by what appears to have been a very interesting day in the Peds ED, lets review a rare but interesting pediatric entity: PYLORIC STENOSIS Background: MC in Males (5:1) & firstborn children (30%) UsuallyRead more

    NextPrevious