Management

• Determine pretest probability, e.g., based on clinical evaluation and/or aortic dissection detection risk score.

• Order initial investigations, e.g., CXR, ECG, laboratory studies.

• Concurrently investigate other potential causes of symptoms: See “Chest pain”, “Syncope”, and “Dyspnea.”

• Maintain a low threshold to obtain definitive imaging for aortic dissection, e.g., CTA.

• Begin therapy based on imaging findings and Stanford classification: See “Treatment.”

The following can help determine the likelihood of aortic dissection compared to other life-threatening causes with overlapping features (e.g., MI, stroke, PE).

• Red flag features accompanying chest pain: These increase the likelihood of aortic dissection.

  • Truncal and/or neck pain

  • Neurological features

  • Syncope

  • Acute limb ischemia

• Aortic dissection detection risk score (ADD-RS): a bedside clinical tool used to assess the risk of acute aortic dissection based on high-risk conditions, pain, and examination features.