R.E.B.E.L.EM - October 23, 2017
Background: Acute Aortic Syndromes (AAS) are life threatening cardiovascular emergencies that are the bane of every emergency physician’s existence. They are diagnostic challenges due to the clinical presentation being highly non-specific. Computed tomography angiography (CTA), Transesophageal Echocardiography (TEE), and Magnetic Resonance Angiography (MRA) can help accurately diagnose AAS. CTA exposes patients to radiation and large doses of intravenous contrast, neither of which is a good enough reason to skip the test in patients you think may have a dissection, but certainly not something we want to do to all patients coming to the ED with chest pain. TEE and MRA may not be available or able to be performed in a timely manner. Having a clinical algorithm that can help physicians reduce misdiagnosis and at the same time avoid over-testing are lacking...
"Author Conclusion: “Integration of ADD-RS (both = 0 or ≤ 1) with DD may be considered to standardize diagnostic rule-out of AAS.”
Clinical Take Home Point:
This is a novel clinical strategy in evaluating patients with the potential of Acute Aortic Syndromes (AAS), but still requires external validation, for reproducibility and comparison to overall clinical gestalt before implementation into clinical practice."