Diagnosing acute aortic syndrome: New guideline for hard-to-
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A new guideline aimed at helping clinicians identify the difficult-to-diagnose acute aortic syndrome is published in CMAJ (Canadian Medical Association Journal).

Acute aortic syndrome (AAS) is a life-threatening condition that underlies 1 in 2000 visits to the emergency department for severe chest or back pain. The rate of misdiagnosis is estimated to be as high as 38%, and the risk of death can increase 2% for every hour of delay in diagnosis.

Recommendations include:

Assessment of risk factors, pain features and high-risk physical exam findings to establish pre-test disease risk.

- Risk factors include connective tissue disease, aortic valve disease, recent aortic procedure, aortic aneurysm and family history of AAS
- High-risk pain includes sudden-onset or thunderclap pain, severe or worst-ever pain, tearing, migrating or radiating pain
- High-risk physical exam findings include aortic regurgitation, pulse deficit, neurological deficit and hypotension/pericardial effusion

Diagnostic strategy

The guideline recommends no investigation of those at low risk, D-dimer testing of people of moderate risk and immediate electrocardiogram-gated computed tomography (CT) of the aorta for high-risk individuals

To help with decision-making, the guideline group created a clinical decision aid to accompany the guideline.

The guideline can be adapted by clinicians based on local circumstances, as a one-size-fits-all approach may not be feasible.

Note: This list is a brief compilation of some of the key recommendations included in the article and is not exhaustive and does not constitute medical advice.

Kindly refer to the original publication here: https://www.cmaj.ca/content/192/29/E832