Diagnostic Score to Differentiate Acute Aortic Dissection in the Emergency Room

Abstract

cute aortic dissection (AAD) and acute coronary syndrome (ACS) are life-threatening cardiovascular emergencies that can be difficult to differentiate in the emergency room (ER), particularly if ACS is complicated with AAD, in which case the clinical signs of AAD may be overlooked. The diagnosis in the ER will affect the choice of treatment and, therefore, prognosis.Electrocardiography, cardiac ultrasonography, and myocardial markers can diagnose ACS, but the clinical symptoms and signs of AAD can be confusing. Enhanced computed tomography (CT) is valuable for diagnosis when AAD is suspected in the ER, although the rate of correct diagnosis has been reported as 40-74%. 1,2 Because AAD progresses to fatal complications within the first 48 h, mortality rates increase at the rate of 1-2% per hour. Other reports have indicated a 9-39% perioperative mortality rate for type-A AAD. [3][4][5] Thus, the correct differential diagnosis of AAD and ACS in the ER is critical 6,7 and the goal of the present study was to establish a diagnostic standard (ERAAD score) by clarifying information that is specific to AAD. Methods Study DesignStudy 1 In order to define the features of AAD and ACS we evaluated 131 patients with AAD or ACS who were admitted between April 2001 and March 2002. The clinical information included age, gender, presence of back pain, systolic and diastolic blood pressures (BP), serum creatine kinase level, ST-T segment changes on electrocardiograms (ECG), mediastinum thoracic ratio (MTR; Fig 1) and cardiothoracic ratio (CTR) on chest X-rays, and aortic regurgitation (AR) and aortic diameter on cardiac ultrasonograms, as well as history of smoking, hypertension, hyperlipidemia or diabetes mellitus. We scored the total number of indexes specific to AAD for each patient to obtain the ERAAD score. J 2008; 72: 986 -990 (Received October 20, 2007; revised manuscript received January 8, 2008; accepted January 17, 2008 Circ

A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection

“…25 The ability of a clinical score to risk-stratify is further supported by 2 other studies that used clinical parameters to successfully identify low-risk populations. 26,27 Evidence for the second step in the strategy to rule out acute aortic dissection with D-dimer testing is provided by this meta-analysis. With a cutoff of 0.50 mg/mL, the negative likelihood ratio was determined to be 0.05.…”

Painless Acute Aortic Dissection - Diagnostic, Prognostic and Clinical Implications -

“…The first problem is being able to distinguish AAD from an acute myocardial infarction in patients having chest or back pain. [30][31][32] A rapid distinction between these 2 diseases is important since minimizing the time to the initiation of reperfusion therapy leads to a maximum benefit for an acute myocardial infarction, while erroneous reperfusion therapy for AAD can produce harmful outcomes. The second problem is identifying patients who have painless AAD and providing the appropriate treatment without delay.…”

Leaking abdominal aortic aneurysm mimicking ureteric colic: So rare but so real in Middle East

“…[4] The clinical predictors or risk factors are hypertension, Marfan syndrome, male sex, and advanced age. [5] Smoking is associated with 3–5 times increased risk of having aortic aneurysms. [6] There is no single diagnostic modality which can accurately diagnose AAD.…”