Nazerian et al developed the aortic dissection detection (ADD) score to evaluate a patient for dissecting thoracic aortic aneurysm. They subsequently modified this by addition of the D-Dimer concentration. The authors are from Careggi University Hospital and Molinette Hospital in Italy.
Patient selection: chest pain with suspected aortic dissection
Parameters:
(1) ADD score (0, <= 1 or > 1)
(2) D-dimer concentration in ng/mL (upper limit of normal was 499 ng/mL or 0.499 ng/L)
The specificity of an elevated D-dimer was around 30-37% for all ADD scores.
The sensitivity of an elevated D-dimer was 100% for an ADD 0, 99% for ADD 1 and 98% for ADD > 1.
A negative D-dimer test excludes aortic dissection if the ADD score is 0 and practically excludes dissection if the ADD is 1.
A negative D-dimer for an ADD score > 1 supports an alternative diagnosis while a positive D-dimer supports the diagnosis. In both cases additional data is needed to make the final diagnosis.
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