Diagnostic Score to Differentiate Acute Aortic Dissection in the Emergency Room

Abstract

Background Acute aortic dissection (AAD) is a life-threatening cardiovascular disorder that is similar to acute coronary syndrome (ACS), which means differentiating AAD and ACS is sometimes difficult in an emergency. Methods and Results Specific information from 131 patients with AAD or ACS was analyzed between April 2001 and March 2002. The emergency room AAD (ERAAD) score was defined as the total number of specific indexes for AAD among 15 indexes that were obtainable in the emergency room (Study 1). The clinical applicability of the ERAAD score was also investigated in another 711 patients with AAD or ACS between April 2002 and March 2006 (Study 2). The ERAAD score was based on (1) presence of back pain, (2) mediastinal thoracic ratio >30%, (3) aortic regurgitation and (4) aortic diameter >30 mm on ultrasonography in Study 1. The ERAAD score was significantly higher in patients with AAD than with ACS (3.19±0.83 vs 1.17±0.99) in Study 2. The sensitivity and specificity for AAD were 93.1% and 77.6%, respectively, when the ERAAD score was ≥3. Conclusion The ERAAD score enables clinical diagnosis of AAD and correct treatment. (Circ J 2008; 72: 986 - 990)