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Sensitivity of the Aortic Dissection Detection Risk Score, a Novel Guideline-Based Tool for Identification of Acute Aortic Dissection at Initial Presentation: Results From the International Registry of Acute Aortic Dissection
Study Questions:
What is the sensitivity of the high-risk clinical features developed by the American Heart Association (AHA) and American College of Cardiology (ACC) to assist in the early detection of acute aortic dissection?
Methods:
The investigators examined patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) from 1996 to 2009. The number of patients with confirmed acute aortic dissection who presented with 1 or more of 12 proposed clinical risk markers was determined. An aortic dissection detection (ADD) risk score of 0-3 was calculated on the basis of the number of risk categories (high-risk predisposing conditions, high-risk pain features, high-risk examination features) in which patients met criteria. The ADD risk score was tested for sensitivity. Bivariate analysis was performed with the use of χ2 analysis or two-sided Fisher exact tests where appropriate to identify clinical features more commonly present in patients not identified by the algorithm.
Results:
Of 2,538 patients with acute aortic dissection, 2,430 (95.7%) were identified by 1 or more of 12 proposed clinical risk markers. With the use of the ADD risk score, 108 patients (4.3%) were identified as low risk (ADD score 0), 927 patients (36.5%) were intermediate risk (ADD score 1), and 1,503 patients (59.2%) were high risk (ADD score 2 or 3). Among 108 patients with no clinical risk markers present (ADD score 0), 72 had chest x-rays recorded, of which 35 (48.6%) demonstrated a widened media.
Conclusions:
The authors concluded that clinical risk markers proposed in the 2010 ACC/AHA thoracic aortic disease guidelines and their application as part of the ADD risk score comprise a highly sensitive clinical tool for the detection of acute aortic dissection.
Perspective:
This study suggests that the clinical risk markers proposed in the 2010 ACC/AHA thoracic aortic disease guidelines and their application as part of the ADD risk score comprise a highly sensitive clinical tool for the detection of acute aortic dissection. Given the relative infrequency of acute aortic dissection, which often leads to missed or delayed diagnosis, application of the ADD risk score has the potential to draw necessary clinical attention to the possibility of acute aortic dissection while ensuring that >95% of patients with true dissection undergo further investigation.
Keywords: Risk, Registries, Radiography, Thoracic, Delayed Diagnosis, United States
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