ADvISED Algorithm

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ADvISED Algorithm - An Approach to Rule out Aortic Dissection

Jonathan Cefalo - PGY1

Combined approach of using the ADD-RS and a high sensitivity D-dimer to r/o acute non-traumatic aortic dissection

• ADD-RS is a validated scoring system to risk stratify patients for aortic dissection

• Use of high sensitivity d-dimer in FEU with cutoff value of 500

• Found that ADD-RS = 0 with negative D-dimer had a failure rate of 0.3% (1 missed of 294); ADD-RS ≤1 with negative D-dimer had a failure rate of 0.3% (3 missed of 924)

ADvISED Algorithm

Recommendations

¹ Isselbacher et al., 2022. ² Mazzolai et al., 2024. ³ Czerny et al., 2024. ⁴ Promes et al., 2025.

References

• Czerny, M., et al. (2024). EACTS/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. European Journal of Cardio-Thoracic Surgery, 65(2), ezad426. https://doi.org/10.1093/ejcts/ezad426

• Isselbacher, E. M., Preventza, O., Hamilton Black, J., 3rd, Augoustides, J. G. T., Beck, A. W., Bolen, M. A., Braverman, A. C., Brayman, K. L., Brown-Zimmerman, M. M., Chen, E. P., Collins, T. J., DeAnda, A., 3rd, Fanola, C. L., Girardi, L. N., Hicks, C. W., Hui, D. S., Kachef, M. A., Kim, K. M., Kirsch, E. W., ... Sundt, T. M., 3rd. (2022). 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 146(15), e334–e482. https://doi.org/10.1161/CIR.0000000000001106

• Mazzolai, L., Tepe, G., Lanza, G., et al. (2024). 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. European Heart Journal, 45(36), 3538–3700. https://doi.org/10.1093/eurheartj/ehae179

• Nazerian, P., Mueller, C., Soeiro, A. M., Leidel, B. A., Salvadeo, S. A. T., Giachino, F., Vanni, S., Grimm, K., Oliveira, M. T., Jr., Pivetta, E., Lupia, E., Grifoni, S., Morello, F., & ADvISED Investigators. (2018). Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes: The ADvISED prospective multicenter study. Circulation, 137(3), 250–258. https://doi.org/10.1161/CIRCULATIONAHA.117.029457

• Promes, S. B., et al. (2025). Critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection: A clinical policy. Annals of Emergency Medicine, 86(1), e12–e26. https://doi.org/10.1016/j.annemergmed.2025.04.002

• Ren, S., Essat, M., Pandor, A., Goodacre, S., Ren, S., Clowes, M., Bima, P., Toyofuku, M., McLatchie, R., & Bossone, E. (2024). Diagnostic accuracy of the aortic dissection detection risk score alone or with D-dimer for acute aortic syndromes: Systematic review and meta-analysis. PLOS ONE, 19(6), e0304401. https://doi.org/10.1371/journal.pone.0304401

• Rogers, J., & Hayes, J. (2025, June 12). Aortic dissection detection risk score (ADD-RS). Life in the Fast Lane. https://litfl.com/aortic-dissection-detection-risk-score-add-rs/

Thank You!