The Journal of emergency medicine · 2025
Using Age-Adjusted D-Dimer vs Traditional D-Dimer to Rule Out Acute Aortic Syndromes.
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Nelson Jacob, Patel Divyani, Kashat Sylvia, Geloian Gorune, Childers Karen, Berger David A, Todd Brett
Аннотация
BACKGROUND: Acute aortic syndromes (AS), including aortic dissection, ulceration, and intramural hematoma, are rare and life-threatening diagnoses. Early diagnosis is critical as mortality increases by 1-2% per hour after symptom onset. D-dimer (DD) < 500 ng/dL, with or without utilization of Aortic Dissection Detection Risk Score (ADD-RS), is a proposed method to rule-out AS in low-risk patients but is not specific. Age-adjusted D-dimer (AADD) has been validated for pulmonary embolism, but has not been studied extensively in AS.
OBJECTIVE: In this study, we investigate the utility of AADD to DD when used to rule-out AS, with and without ADD-RS.
METHODS: This is a retrospective study of patients presenting the emergency department (ED) from 2012 to 2021 who received a DD and underwent computed tomography angiography (CTA) for Dissection, Coronary Study, or Triple Rule-Out. Sensitivity and specificity for AS was calculated for both DD < 500 ng/dL and AADD. Patients were excluded if they were pregnant, had prior thoracic aortic dissection or repair, presented altered, or younger than 18 years-old.
RESULTS: In total, 5818 unique cases met inclusion criteria. In the DD < 500 ng/dL group sensitivity was 0.979 (0.939-1.000) with a specificity of 0.727 (0.716-0.739). In the AADD group, sensitivity was 0.938 (0.869-1.000, p = 0.16) with a specificity of 0.781 (0.770-0.792, p < 0.05).
S CONCLUSIONS: AADD appears to have comparable sensitivity, although with a diminished confidence interval, to DD when ruling out AS. Utilization of ADD-RS may help determine which patients are appropriate for screening. Future steps would include a prospective trial on patients presenting to the ED.
OBJECTIVE: In this study, we investigate the utility of AADD to DD when used to rule-out AS, with and without ADD-RS.
METHODS: This is a retrospective study of patients presenting the emergency department (ED) from 2012 to 2021 who received a DD and underwent computed tomography angiography (CTA) for Dissection, Coronary Study, or Triple Rule-Out. Sensitivity and specificity for AS was calculated for both DD < 500 ng/dL and AADD. Patients were excluded if they were pregnant, had prior thoracic aortic dissection or repair, presented altered, or younger than 18 years-old.
RESULTS: In total, 5818 unique cases met inclusion criteria. In the DD < 500 ng/dL group sensitivity was 0.979 (0.939-1.000) with a specificity of 0.727 (0.716-0.739). In the AADD group, sensitivity was 0.938 (0.869-1.000, p = 0.16) with a specificity of 0.781 (0.770-0.792, p < 0.05).
S CONCLUSIONS: AADD appears to have comparable sensitivity, although with a diminished confidence interval, to DD when ruling out AS. Utilization of ADD-RS may help determine which patients are appropriate for screening. Future steps would include a prospective trial on patients presenting to the ED.