Journal Jam 9 – D-dimer to Rule Out Aortic Dissection

The EM Cases Team is very excited to bring you not only a new format for the Journal Jam podcast but a new member of the team, Dr. Rory Spiegel, aka @EMNerd_ an Emergency Medicine physician from The University Maryland Medical Center in Baltimore, the founder of the EM Nerd blog and the co-host of the Annals of EM podcast. The new format sees Justin Morgenstern, Teresa Chan, Rory Spiegel and Anton Helman doing deep dives into the world's literature on specific practical questions while highlighting some important evidence-based medicine concepts. The question we ask in this Journal Jam podcast: Is there a role for D-dimer testing in the workup of aortic dissection in the ED? The Case for this Journal Jam on the role of D-dimer in the Workup of Aortic Dissection A 54 year-old man with a history of hypertension and smoking comes in to your ED with 2 hours of acute onset, sharp non-pleuritic 8/10 constant epigastric that radiates to both shoulders. He vomited once but has no other associated symptoms. His vitals are normal except for a slightly elevated BP, he has no pulse deficit or aortic murmur, abdomen is benign, his ECG shows non-specific T-wave changes and his CXR is normal. A repeat ECG is unchanged and his first troponin, lipase and liver enzymes come back negative.   Could the patient in this case be suffering from an aortic dissection? Does he require a CT aortogram? Is there a role for D-dimer testing in the workup of aortic dissection in the ED? We asked ourselves this last question when we came across a review by Asha in the Annals of Emergency Medicine last year. It claimed that D-dimer has a 98% sensitivity for aortic dissection and that it might be useful to rule out dissection in low risk patients. That’s exciting: A simple blood test to rule out a deadly disease. But is it too good to be true? Listen to the podcast to find out...   Produced by Justin Morgenstern, Anton Helman, Rory Spiegel, Teresa Chan and Anton Nicoline February 2017 Cite this podcast as: Spiegel, R, Morgenstern, J, Chan, T, Helman, A. D-dimer to Rule Out Aortic Dissection. Emergency Medicine Cases. November, 2016. https://emergencymedicinecases.com/ddimer-aortic-dissection/. Accessed [date].    Justin Morgenstern's post on First10EM containing his notes on all the D-dimer for aortic dissection studies. ADD Score for Aortic Dissection   Full pdf of original ADD Score paper   Drs. Helman, Spiegel, Morgenstern and Chan have no conflicts of interest to declare.   References Asha SE, Miers JW. A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection. Ann Emerg Med. 2015 Oct;66(4):368-78. Rogers AM, Hermann LK, Booher AM, et al. Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection. Circulation. 2011;123(20):2213-8. Suzuki T, Distante A, Zizza A, et al; IRAD-Bio Investigators. Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation. 2009 May 26;119(20):2702-7. Nazerian P, Morello F, Vanni S, Bono A, Castelli M, Forno D, Gigli C, Soardo F, Carbone F, Lupia E, Grifoni S. Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute a...