Aortic Dissection Detection Risk Score (ADD-RS)

What goes into the ADD-RS (aortic dissection)

• High-risk condition: Marfan or connective tissue disease, family history of aortic disease, known aortic valve disease or thoracic aneurysm, recent aortic manipulation (+1)
• High-risk pain: abrupt, severe, or ripping or tearing (+1)
• High-risk exam: pulse deficit or SBP difference, focal neuro deficit with pain, new aortic regurgitation murmur with pain, or hypotension or shock (+1)

How to interpret the result

• 0–1 with D-dimer < 500 ng/mL: acute aortic syndrome very unlikely (ADvISED study)
• 0–1 with raised D-dimer: CT angiography
• 2–3: CT angiography directly

Clinical pearls

• Score by category (maximum 3), not by individual feature.
• D-dimer can be normal in intramural hematoma or a thrombosed false lumen; trust high clinical suspicion.
• The 2022 ACC/AHA aortic disease guideline recommends a structured risk assessment such as ADD-RS.

Evidence

1. Rogers 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. Circulation. 2011;123:2213-2218.
2. Nazerian P, et al. Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes: the ADvISED prospective multicenter study. Circulation. 2018;137:250-258.

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