D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature

Sutherland, Alexander; Escano, Jude; Coon, Troy P.

doi:10.1016/j.annemergmed.2007.12.026

Cited by 30 publications

(17 citation statements)

References 12 publications

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“…Elevated plasma D-dimer levels [19-21] and plasma smooth muscle myosin heavy chain protein [22] have shown some diagnostic promise but are not routinely obtained on initial presentation. A protocol for or obtaining routine plasma D-dimer studies was not used in the present study but has been advocated by others [23].…”

Section: Discussionmentioning

confidence: 99%

Early recognition of acute thoracic aortic dissection and aneurysm

et al. 2013

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BackgroundThoracic aortic dissection (TAD) and aneurysm (TAA) are rare but catastrophic. Prompt recognition of TAD/TAA and differentiation from acute coronary syndrome (ACS) is difficult yet crucial. Earlier identification of TAA/TAD based upon routine emergency department screening is necessary.MethodsA retrospective analysis of patients that presented with acute thoracic complaints to the ED from January 2007 through June 2012 was performed. Cases of TAA/TAD were compared to an equal number of controls which consisted of patients with the diagnosis of ACS. Demographics, physical findings, EKG, and the results of laboratory and radiological imaging were compared. P-value of > 0.05 was considered statistically significant.ResultsIn total, 136 patients were identified with TAA/TAD, 0.36% of patients that presented with chest complaints. Compared to ACS patients, TAA/TAD group was older (68.9 vs. 63.2 years), less likely to be diabetic (13% vs 32%), less likely to complain of chest pain (47% vs 85%) and head and neck pain (4% vs 17%). The pain for the TAA/TAD group was less likely characterized as tight/heavy in nature (5% vs 37%). TAA/TAD patients were also less likely to experience shortness of breath (42% vs. 51%), palpitations (2% vs 9%) and dizziness (2% vs 13%) and had a greater incidence of focal lower extremity neurological deficits (6% vs 1%), bradycardia (15% vs. 5%) and tachypnea (53% vs. 22%). On multivariate analysis, increasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction were independent predictors of ACS.ConclusionsIncreasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction can be used to differentiate acute coronary syndromes from thoracic aortic dissections/aneurysms.

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Section: Discussionmentioning

confidence: 99%

Early recognition of acute thoracic aortic dissection and aneurysm

et al. 2013

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“…[13] A proposed explanation for false negative D-dimer assays is the occurrence of an aortic dissection variant featuring an anatomic thrombosed lumen which does not communicate with circulating blood, isolating the clot from detection by serum testing. [13,14] Furthermore, there is no evidence that D-dimer testing can be incorporated into a larger risk stratification strategy that would allow clinicians to sensitively exclude aortic dissection without greatly expanding the number of patients who receive advanced imaging studies. Given the experience with D-dimer testing to rule out pulmonary embolism–which has increased the number of advanced imaging studies ordered without increasing the number of pulmonary embolism diagnoses– [15] a comprehensive approach that accounts for false negatives and false positives should be validated before D-dimer testing is used routinely in the diagnosis of aortic dissection.…”

Section: Diagnosismentioning

confidence: 99%

Screening, Evaluation, and Early Management of Acute Aortic Dissection in the ED

Strayer

Shearer²,

Hermann³

2012

CCR

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Acute aortic dissection (AAD) is a rare and lethal disease with presenting signs and symptoms that can often be seen with other high risk conditions; diagnosis is therefore often delayed or missed. Pain is present in up to 90% of cases and is typically severe at onset. Many patients present with acute on chronic hypertension, but hypotension is an ominous sign, often reflecting hemorrhage or cardiac tamponade. The chest x-ray can be normal in 10-20% of patients with AAD, and though transthoracic echocardiography is useful if suggestive findings are seen, and should be used to identify pericardial effusion, TTE cannot be used to exclude AAD. Transesophageal echocardiography, however, reliably confirms or excludes the diagnosis, where such equipment and expertise is available. CT scan with IV contrast is the most common imaging modality used to diagnose and classify AAD, and MRI can be used in patients in whom the use of CT or IV contrast is undesirable. Recent specialty guidelines have helped define high-risk features and a diagnostic pathway that can be used the emergency department setting. Initial management of diagnosed or highly suspected acute aortic dissection focuses on pain control, heart rate and then blood pressure management, and immediate surgical consultation.

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“…Theoretically, the D‐dimer should be used only to exclude acute venous thrombosis, pulmonary embolism,16 aortic dissection,11 or other diseases 12. Therefore, in this study, all cases were equally considered “rule‐in” cases that were further evaluated for the “likelihood” of D‐dimer‐related diseases, including DVT.…”

Section: Discussionmentioning

confidence: 99%

“…In the differential diagnosis for the positive D‐dimer, we defined D‐dimer‐related diseases as DVT or pulmonary embolism,6, 10 aortic dissection,11 disseminated intravascular coagulopathy,12 and others. Documentation data were collected in a sentence, and two authors, D.T.…”

Section: Methodsmentioning

confidence: 99%

Better documentation in electronic medical records would lead to an increased use of lower extremity venous ultrasound in the inpatient setting: a retrospective study

Takechi

Dote

Kim

et al. 2017

Acute Medicine & Surgery

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AimWe hypothesized that the quality of the assessment of abnormal laboratory data in the emergency department (ED) could affect the hospital‐attending physicians’ decision‐making after a patient's hospitalization. To test this hypothesis, we investigated how patients with a positive D‐dimer result were reported by ED physicians in electronic medical records, and measured whether lower extremity venous ultrasonography examination was undertaken during hospitalization by the hospital‐attending physicians.MethodsIn an urban tertiary acute care general hospital in Japan, between January 2012 and December 2013, we included patients hospitalized after a positive D‐dimer measurement (≥1.0 μg/mL) that was taken in the emergency department. We retrospectively measured the quality of ED physician assessments. Then we examined whether that affected the decisions of attending physicians to order lower extremity venous ultrasonography examinations during hospitalization. The exposure variable was the quality of the ED physicians’ assessment of patients with positive D‐dimer results. The outcome was whether a lower extremity venous ultrasonography examination was ordered by the attending physician during hospitalization.ResultsWhen assessments were described by ED physicians for patients with positive D‐dimer results, the attending physicians frequently ordered lower extremity venous ultrasonography (odds ratio, 10.74; 95% confidence interval, 5.92–19.50), even if the assessments only contained “copied and pasted” laboratory data (odds ratio, 1.68; 95% confidence interval, 2.10–2.40).ConclusionsBetter documentation by ED physicians, regarding patients with positive D‐dimer results, strongly affected the decisions made by attending physicians to order lower extremity venous ultrasonography examination.

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D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature

Cited by 30 publications

References 12 publications

Early recognition of acute thoracic aortic dissection and aneurysm

Early recognition of acute thoracic aortic dissection and aneurysm

Screening, Evaluation, and Early Management of Acute Aortic Dissection in the ED

Better documentation in electronic medical records would lead to an increased use of lower extremity venous ultrasound in the inpatient setting: a retrospective study

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