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.