Aortic Dissection: Likelihood Ratios

Introduction: Part of the spectrum of acute aortic syndromes, involving separation of the intima from the media of the aorta. This can progress to rupture as well as causing end-organ ischemia by involving branch arteries.

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The likelihood ratios of findings for Aortic Dissection are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
Chest CT	50	0	Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999
MRI	49	0	Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999
Trans-Esophageal Echocardiography	19.6	0	Limited for portions of the aortic arch Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999
Widened mediastinum	9	0.1	on chest x-ray (various measures). For example, left mediastinal width >= 4.95 cm Study: Emerg Radiol. 2012 Aug;19(4):309-15. PMID: 22415593

Good Negative Likelihood Ratio

Hypertension
Duplicate

1.6

0.5

history of

Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527

Good Positive Likelihood Ratio

Pulse Deficit

5.7

0.7

i.e. differential pulse count in different vessels versus the heart

Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527

Poorly Diagnostic Findings

Finding	+LR	-LR	Comments, Study
Diastolic Murmur	1.4	0.9	Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Elevated D-dimer	Sensitivity = 94%		Obviously non-specific, as many other causes of chest pain cause elevated D-dimer (e.g. Pulmonary Embolism). Study: J Emerg Med. 2008 May;34(4):367-76. PMID: 18207693
Pain	Sensitivity = 90%		Anywhere Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Chest Pain	Sensitivity = 67%		Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Hypertension Duplicate	Sensitivity = 49%		at time of presentation Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Tearing Pain	Sensitivity = 39%		The two studies that reported specificity in this article had widely varied sensitivity. This is a pooled sensitivity from several articles. Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Pain radiating to Back	Sensitivity = 32%		Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Shock	Sensitivity = 19%		Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Focal Neurological Signs	Sensitivity = 17%		Results too variable to report but PLR 6-33, so good positive predictive value. Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Friction rub, pericardial	Sensitivity = 6%		Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
Marfan Syndrome	Sensitivity = 5%		Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527