Acute Aortic Syndrome
Conditions
Brief summary
The goal of this study is to evaluate the safety of integrating the Aortic Dissection Detection Risk Score (ADD-RS) and D-dimer testing for ruling out acute aortic syndrome (AAS) in the emergency department (ED). The main question it aims to answer: Can the combination of the ADD-RS \<2, and D dimer \<500ng/mL rule-out AAS in ED patients without CTA? The researchers will recruit patients suspected with AAS in the ED, and the patients will receive a ADD-RS score, a D-dimer testing after signing a written consent.
Interventions
DIAGNOSTIC_TESTD-dimer test
The patient will receive a ADD-RS calculated by the clinician, evaluating high-risk conditions, high-risk pain features and high-risk physical signs of AAS. A point-of-care D-dimer test will be performed after routine blood taking. The research personnel will collect the above data from the clinician.
Sponsors
Chinese University of Hong Kong
Prince of Wales Hospital, Shatin, Hong Kong
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients aged ≥ 18 years; AND * Presentation to the ED with any of the following symptoms: acute onset (\<14 days) chest pain, abdominal pain, back pain, syncope, or signs of malperfusion (e.g. limb ischemia, neurological deficit); AND * AAS is considered as a possible differential diagnosis by the treating physician. Enrolment in the study will be determined by the attending physician during initial medical consultation in the ED and prior to establishing a final diagnosis.
Exclusion criteria
* An alternative diagnosis to AAS established by the treating physician after the initial assessment; OR * Trauma cases; OR * Patients with a known diagnosis of AAS before the index ED visit (e.g. with a diagnostic imaging done before the ED visit or referral from other institutions for AAS); OR * Clinical severity or other conditions not allowing complete evaluation/proper enrolment; OR * Patient who refuse to participate.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| incidence of missed AAS within 30 days among patients identified as low risk (ADD-RS <2 and D-dimer <500 ng/mL) who did not undergo CTA | From enrollment to 30 days after index visit | number of patients with ADD-RS \<2 and a negative D-dimer who were actually AAS cases |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| sensitivity of the proposed algorithm | From enrolment to 30 days after the index visit | The sensitivity of using ADD-RS and D-dimer to rule out AAS without performing CTA in the ED |
Countries
Hong Kong
Contacts
CONTACTColin Graham, Professor
CONTACTRebecca Li, Miss
Outcome results
None listed