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.

[Edit Diagnosis] [Merge dx] [Add prevalence]

Tags: Vascular Tag this Diagnosis.

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

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Blood Test
Finding	Result	+LR	-LR
[ + ] 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

Fluid Test
Finding	Result	+LR	-LR
[ + ] Hypertension	+ 0 -	1.6	0.5
history of Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
[ + ] Hypertension		Sensitivity = 49%
at time of presentation Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527

History
Finding	Result	+LR	-LR
[ + ] Chest Pain		Sensitivity = 67%
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

Imaging
Finding	Result	+LR	-LR
[ + ] MRI	+ 0 -	49	0
Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999
[ + ] Trans-Esophageal Echocardiography	+ 0 -	19.6	0
Limited for portions of the aortic arch Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999

lr
Finding	Result	+LR	-LR
[ + ] Hypertension	+ 0 -	1.6	0.5
history of Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
[ + ] Hypertension		Sensitivity = 49%
at time of presentation Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527

Physical Exam
Finding	Result	+LR	-LR
[ + ] 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
[ + ] Hypertension	+ 0 -	1.6	0.5
history of Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
[ + ] Hypertension		Sensitivity = 49%
at time of presentation Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527

Toxic
Finding	Result	+LR	-LR
[ + ] Hypertension	+ 0 -	1.6	0.5
history of Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
[ + ] Hypertension		Sensitivity = 49%
at time of presentation Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527

Untagged
Finding	Result	+LR	-LR
[ + ] Chest CT	+ 0 -	50	0
Study: Arch Intern Med. 2006 Jul 10;166(13):1350-6. PMID: 16831999
[ + ] Diastolic Murmur	+ 0 -	1.4	0.9
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
[ + ] Pain		Sensitivity = 90%
Anywhere Study: JAMA. 2002 May 1;287(17):2262-72. PMID: 11980527
[ + ] Pulse Deficit	+ 0 -	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
[ + ] Shock		Sensitivity = 19%
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
[ + ] Widened mediastinum	+ 0 -	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