JAMA- Aortic Dissection [Likelihood Ratios]

SYMPTOMS THAT RULE OUT  (Lowest -LR): 

The absence of pain of sudden onset substantively decreases the probability of dissection (negative LR, 0.3;95% CI, 0.2-0.5).

SYMPTOMS THAT RULE IN (Highest +LR): 

The presence of tearing or ripping pain (positive LR, 1.2-10.8) or pain that migrates (positive LR, 1.1-7.6) may prove useful.

FINDINGS THAT RULE IN (Highest +LR): 

Pulse deficits (positive LR, 5.7; 95% CI, 1.4-23.0) or focal neurological deficits (positive LR, 6.6-33.0)

FINDINGS THAT RULE OUT (Lowest -LR): 

A normal aorta and mediastinum on chest radiograph helps exclude the diagnosis (negative LR, 0.3; 95% CI,0.2-0.4) 

KEY POINT: No single test definitely rules in or out Aortic Dissection, so diagnostic imaging (CTA) will be necessary!

The presence or absence of a diastolic murmur is not useful (positive LR, 1.4; negative LR, 0.9)

REFERENCES

Klompas M. Does This Patient Have an Acute Thoracic Aortic Dissection? JAMA. 2002;287(17):2262–2272. doi:https://doi.org/10.1001/jama.287.17.2262