Bedside Screening Identifies Patients with Acute Aortic Dissection

New guidelines have been found to be effective in diagnosing an acute aortic dissection (AAD), one of the most lethal and sudden cardiovascular events.

Researchers at the University of Michigan (UM; Ann Arbor, USA) developed a fast, simple, and systematic method for screening large volumes of patients with suspected AAD at the bedside. To test the proposed clinical markers, the researchers examined the medical records of 2,538 patients enrolled in the International Registry of AAD from 1996 to 2009; of these, the number of patients with confirmed AAD who presented with 1 or more of 12 proposed clinical risk markers was determined. An aortic dissection detection (ADD) risk score of 0-3 was calculated on the basis of the number of risk categories (high-risk predisposing conditions, high-risk pain features, high-risk examination features) in which patients met criteria.

The results showed that of the 2,538 patients with AAD, 2,430 (95.7%) were identified by 1 or more of 12 proposed clinical risk markers. With the use of the ADD risk score, 108 patients (4.3%) were identified as low risk (ADD score 0), 927 patients (36.5%) were intermediate risk (ADD score 1), and 1,503 patients (59.2%) were high risk (ADD score 2 or 3). Among the 108 patients with an ADD score of 0, 72 had chest X-rays recorded, of which 35 (48.6%) demonstrated a widened mediastinum. The study was published online ahead of print on May 24, 2011, in Circulation.

"The results from this study suggest that the risk score, with the use of only information that is available at the bedside, can identify the vast majority of patients presenting with acute aortic dissection,” said senior author and cardiologist Kim Eagle, MD, of the UM cardiovascular center.

AAD occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the aorta wall and force them apart. AAD can quickly lead to death, even with optimal treatment. If the dissection tears the aorta completely open (through all three layers), massive and rapid blood loss occurs. Aortic dissections resulting in rupture have an 80% mortality rate and 50% of patients die before they even reach the hospital. If the dissection reaches 6 cm, the patient must be taken for emergency surgery.

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