Clinical Prediction Rules of Von Kodolitsch et al for Acute Aortic Dissection

The authors are from the University Hospital Eppendorf in Hamburg, Germany and Karmanos Cancer Insitute in Detroit, Michigan.

 

Patient selection:

(1) Patients were evaluated if they presented to the Emergency Department with the onset of chest or back pain in the preceding 2 weeks.

(2) Patients were included if considered clinically suspicious for acute aortic dissection by 2 experienced emergency room physicians.

(3) Patients were excluded if (1) a non-aortic cause for the pain was identified, (2) the patient was comatose, or (3) there was a history of recent trauma or recent surgery.

 

Parameters:

(1) pain onset and character

(2) mediastinal and aortic widening on imaging studies

(3) pulse and blood pressure differentials

 

Parameter	Subparameter A	Subparameter B	Findings	Points
1	immediate onset of pain	pain with a ripping or tearing character	neither	0
			one or both	1
2	mediastinal widening	aortic widening	neither	0
			one or both	1
3	pulse differential	blood pressure differential	neither	0
			one or both	1

 

where:

• "aortic pain": either immediate onset of pain, or pain with ripping/tearing character

• immediate onset of pain: onset within 2 minutes

• ripping or tearing character: ripping, tearing, lacerating, "something inside tore loose"

• pulse differential: absence of a proximal extremity or carotid pulse

• blood pressure differential: difference in systolic blood pressure between the 2 arms > 20 mm Hg

 

risk score =

= SUM(points for the 3 clinical parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 3

• The higher the score the greater the likelihood of aortic dissection.

 

Risk Score	Risk Group	Percent with Aortic Dissection
0	low	7%
1 with Parameter 1 only	intermediate	31%
1 with Parameter 2 only	intermediate	39%
1 with Parameter 3 only	high	100%
2 with Parameter 1+2	high	83%
2 with Parameter 1+3	high	92%
2 with Parameter 3 + mediastinal widening	high	100%
3	high	100%

 

where:

• The risk for mediastinal widening + Parameter 3 is stated. However, the risk for aortic widening alone + Parameter 3 is not explicitly stated. I have assumed that it is also 100% since item 3 alone is 100%; the worst case might be 92% which also would be high risk.