2017/12/19 by Robert Ohle, Hashim Kareemi, George A. Wells +1 · 1 citation
Medicine · #Aortic Disease and Treatment Approaches #Aortic aneurysm repair treatments #Cardiac Valve Diseases and Treatments #Medicine #Meta-analysis #Aortic dissection #MEDLINE #Intensive care medicine #Surgery #Internal medicine #Aorta
paper · pdf · doi:10.1111/acem.13360
openalex publication_date 2017/12/19 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/29
Abstract Objectives Acute aortic dissection is a life‐threatening condition due to a tear in the aortic wall. It is difficult to diagnose and if missed carries a significant mortality. Methods We conducted a librarian‐assisted systematic review of PubMed, MEDLINE, Embase, and the Cochrane database from 1968 to July 2016. Titles and abstracts were reviewed and data were extracted by two independent reviewers (agreement measured by kappa). Studies were combined if low clinical and statistical heterogeneity (I 2 < 30%). Study quality was assessed using the QUADAS‐2 tool. Bivariate random effects meta analyses using Revman 5 and SAS 9.3 were performed. Results We identified 792 records: 60 were selected for full text review, nine studies with 2,400 participants were included (QUADAS‐2 low risk of bias, κ = 0.89 [for full‐text review]). Prevalence of aortic dissection ranged from 21.9% to 76.1% (mean ± SD = 39.1% ± 17.1%). The clinical findings increasing probability of aortic dissection were 1) neurologic deficit ( n = 3, specificity = 95%, positive likelihood ratio [LR+] = 4.4, 95% confidence interval [CI] = 3.3–5.7, I 2 = 0%) and 2) hypotension ( n = 4, specificity = 95%, LR+ = 2.9 95% CI = 1.8–4.6, I 2 = 42%), and decreasing probability were the absence of a widened mediastinum ( n = 4, sensitivity = 76%‐95%, negative likelihood ratio [LR–] = 0.14–0.60, I 2 = 93%) and an American Heart Association aortic dissection detection (AHA ADD) risk score < 1 ( n = 1, sensitivity = 91%, LR– = 0.22, 95% CI = 0.15–0.33). Conclusions Suspicion for acute aortic dissection should be raised with hypotension, pulse, or neurologic deficit. Conversely, a low AHA ADD score decreases suspicion. Clinical gestalt informed by high‐ and low‐risk features together with an absence of an alternative diagnosis should drive investigation for acute aortic dissection.