High risk clinical features for acute aortic dissection: A case control study

Abstract

Background

Acute aortic dissection (AAD) is a rare condition with a high mortality that is often missed. The objective of our study was to assess the diagnostic accuracy of clinical and laboratory findings for AAD, in confirmed cases of AAD and a low risk control group.

Methods

Historical matched case-control study: participants were adults >18 years old presenting to two tertiary care emergency departments (ED) or one regional cardiac referral center. Cases: new ED or in-hospital diagnosis of non-traumatic AAD confirmed by computed tomography or echocardiography. Controls: triage diagnosis of truncal pain (< 14 days) and an absence of a clear diagnosis on basic investigation. Cases and controls were matched in a 1:4 ratio by sex and age. A sample size of 165 cases and 660 controls was calculated based on 80% power and confidence interval of 95% to detect an odds ratio of greater than 2.

Results

Data were collected from 2002-2014 yielding 194 cases of AAD and 776 controls (mean age of 65(SD 14.1) and 66.7% male). Absence of abrupt-onset pain (Sensitivity 95.9% negative likelihood ratio (LR-) 0.07(0.03-0.14)) can help rule out AAD. Presence of tearing/ripping pain (Specificity 99.7%, LR+42.1 (9.9-177.5), aortic aneurysm (Specificity 97.8%, LR+6.35(3.54-11.42)), hypotension (Specificity 98.7%, LR+ 17.2(8.8-33.6)), pulse deficit (Specificity 99.3, LR+ 31.1(11.2-86.6)), neurological deficits (Specificity 96.9%, LR+ 5.26(2.9-9.3)), and a new murmur (Specificity 97.8%, LR+ 9.4(5.5-16.2)) can help rule in the diagnosis of AAD.

Conclusions

Patients with one or more high-risk feature should be considered high risk, whereas patients with no high risk and multiple low risk features are at low risk for AAD.

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