• Drew A Long, Samuel M Keim, Michael D April, Alex Koyfman, Brit Long, and Felix Ankel.
• Department of Emergency Medicine, William Beaumont Army Medical Center, El Paso, Texas.
• J Emerg Med. 2021 Nov 1; 61 (5): 627-634.

BackgroundAortic 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 QuestionCan a negative D-dimer in low-risk patients exclude AD in the emergency department?Evidence ReviewRetrieved 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.ConclusionsNeither 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.Copyright © 2021 Elsevier Ltd. All rights reserved.

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