In patients at low clinical probability of acute aortic syndromes (AASs), decision on advanced aortic imaging is cumbersome. Integration of the aortic dissection detection risk score (ADD-RS) with D-dimer (DD) provides a potential pipeline for standardized diagnostic rule-out. We systematically reviewed and summarized supporting data.
Cross-sectional studies assessing integration of ADD-RS with DD for diagnosis of AASs were identified on MEDLINE, EMBASE and Web Of Science databases. Two reviewers independently screened articles, assessed quality and extracted data. The quality of design and reporting was evaluated with the QUADAS-2 and STARD tools. Individual patient data were obtained, to allow analysis of both conventional (500 ng/mL) and age-adjusted (DD ) DD cutoffs. Data were summarized for 4 diagnostic strategies combining ADD-RS=0 or ≤1, with DD<500 ng/mL or

After screening of 680 studies, 4 articles (including a total of 3804 patients) met inclusion criteria. One prospective study provided a low risk of bias/applicability concerns, while methodological limitations were found in the other 3 retrospective studies. Statistical heterogeneity was negligible for sensitivity and negative likelihood ratio (LR) values, and significant for specificity and positive LR values of all diagnostic strategies. Pooled sensitivity was 99.9% (95%CI 99.3-100%, I =0) for ADD-RS=0 and DD<500 ng/mL or
Despite methodological limitations, integration of ADD-RS=0 or ≤1 with DD<500 ng/mL shows negligible heterogeneity and consistently high sensitivity across studies, thus supporting reliability for diagnostic rule-out of AASs. Data supporting ADD-RS=0 plus DD appear preliminary and require further scrutiny.

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