Does clinical examination accurately rule in or rule out acute thoracic aortic dissection in suspected patients?
Clinical examination features can alter the likelihood of acute thoracic aortic dissection but are insufficiently sensitive to safely rule it out, necessitating further diagnostic testing.
The presence of pulse deficits or focal neurological deficits increases the likelihood of an acute thoracic aortic dissection in the appropriate clinical setting. Conversely, a completely normal chest radiograph result or the absence of pain of sudden onset lowers the likelihood. Overall, however, the clinical examination is insufficiently sensitive to rule out aortic dissection given the high morbidity of missed diagnosis.
Michael Klompas (2002) studied this question.