Can D-Dimer in Low-Risk Patients Exclude Aortic Dissection in the Emergency Department?

Drew A. Long, Samuel M. Keim, Michael D. April, Alex Koyfman, Brit Long, Felix Ankel

Research output: Contribution to journalComment/debatepeer-review

1 Scopus citations

Abstract

Background: Aortic dissection (AD) is a challenging diagnosis associated with severe mortality. However, acute AD is a rare clinical entity and can be overevaluated in the emergency department. D-dimer, both alone and in combination with the Aortic Dissection Detection Risk Score (ADD-RS), has been studied as a tool to evaluate for AD. Clinical Question: Can a negative D-dimer in low-risk patients exclude AD in the emergency department? Evidence Review: Retrieved studies included three systematic review and meta-analyses and two prospective cohort studies. D-dimer was found to be highly sensitive for acute AD, with a sensitivity of 98.0%. The ADD-RS was also highly sensitive (95.7%) for AD. Two meta-analyses reported a combination of a negative D-dimer and ADD-RS < 1 to have a pooled sensitivity of 99.9% and 100% for acute aortic syndrome. Conclusions: Neither D-dimer nor the ADD-RS alone provides adequate sensitivity to exclude acute AD. However, a negative D-dimer combined with an ADD-RS < 1 is likely sufficient to rule out AD. Even with these findings, physicians must place clinical judgment above laboratory testing or scoring systems when deciding whether to pursue a diagnosis of acute AD.

Original languageEnglish (US)
Pages (from-to)627-634
Number of pages8
JournalJournal of Emergency Medicine
Volume61
Issue number5
DOIs
StatePublished - Nov 2021

Keywords

  • D-dimer
  • acute aortic syndrome
  • aortic dissection
  • risk score

ASJC Scopus subject areas

  • Emergency Medicine

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