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Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute aortic dissection

  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    ,
    Author Footnotes
    2 These authors contributed equally to the study.
    Peiman Nazerian
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    2 These authors contributed equally to the study.
    Affiliations
    Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    ,
    Author Footnotes
    2 These authors contributed equally to the study.
    Fulvio Morello
    Correspondence
    Corresponding author at: Emergency Department, A.O. Città della Salute e della Scienza, Molinette Hospital, C.so Bramante 88, 10126 Torino, Italy. Tel.: +39 011 6337122; fax: +39 011 6335082.
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    2 These authors contributed equally to the study.
    Affiliations
    Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Simone Vanni
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Alessia Bono
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
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    Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Matteo Castelli
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    Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Daniela Forno
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
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    Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
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    Chiara Gigli
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    Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Flavia Soardo
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
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    Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Federica Carbone
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
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    Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Enrico Lupia
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Emergency, A.O. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Stefano Grifoni
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    2 These authors contributed equally to the study.

      Highlights

      • We evaluated ADD risk score plus D-dimer for the rule-out of aortic dissection.
      • D-dimer <500 ng/mL had a sensitivity of 100% in patients with ADD risk score 0.
      • D-dimer <500 ng/mL had a sensitivity of 98.7% in patients with ADD risk score ≤1.
      • ADD risk score 0/≤1 plus D-dimer <500 ng/mL accurately ruled-out aortic dissection.

      Abstract

      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.

      Keywords

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