Do clinical examination features and the AHA ADD risk score accurately identify acute aortic dissection?
Clinical gestalt combining high- and low-risk features, such as the AHA ADD score, is useful for guiding the investigation of acute aortic dissection.
OBJECTIVES: Acute aortic dissection is a life-threatening condition due to a tear in the aortic wall. It is difficult to diagnose and if missed carries a significant mortality. METHODS: < 30%). Study quality was assessed using the QUADAS-2 tool. Bivariate random effects meta analyses using Revman 5 and SAS 9.3 were performed. RESULTS: = 93%) and an American Heart Association aortic dissection detection (AHA ADD) risk score < 1 (n = 1, sensitivity = 91%, LR- = 0.22, 95% CI = 0.15-0.33). CONCLUSIONS: Suspicion for acute aortic dissection should be raised with hypotension, pulse, or neurologic deficit. Conversely, a low AHA ADD score decreases suspicion. Clinical gestalt informed by high- and low-risk features together with an absence of an alternative diagnosis should drive investigation for acute aortic dissection.
Ohle et al. (Tue,) studied this question.