Efficiency Analysis of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes in Athletes

Abstract

Objective: To assess the effectiveness of combining the Aortic Dissection Detection Risk Score (ADD-RS) with D-dimer levels in diagnosing Acute Aortic Syndromes (AAS) in athletes presenting with chest pain.

Method: This retrospective study analyzed 338 athletes admitted to the emergency department with chest pain between January 2018 and June 2018, with D-dimer levels measured upon admission. The ADD-RS was calculated for each patient, and diagnoses of AAS and acute pulmonary embolism (PE) were confirmed via 64 multi-detector computed tomography (CT) scans. Other diagnoses were confirmed through discharge assessments.

Results: D-dimer levels were significantly higher in athletes with AAS (median (interquartile range) 6.1(4.1-10.9) ug/ml) compared to those without (median (interquartile range) 0.4(0.3-0.7) ug/ml), P<0.001. At a D-dimer cut-off of 0.5 ug/ml, the sensitivity for detecting AAS was 0.931 (95% CI, 0.839-0.974) with a negative predictive value of 0.962 (95% CI, 0.909-0.986). When ADD-RS was ≤1, a positive D-dimer test had a sensitivity of 0.956 (95% CI, 0.836-0.992), a specificity of 0.494 (95% CI, 0.428-0.559), and a negative predictive value of 0.983 (95% CI, 0.933-0.997) for diagnosing AAS, with a failure rate of 1.7%. When ADD-RS was >1, the sensitivity was 0.889 (95% CI, 0.697-0.971), specificity was 0.424 (95% CI, 0.260-0.606), and the negative predictive value was 0.824 (95% CI, 0.558-0.953), with a failure rate of 17.6%.

Conclusion: The integration of ADD-RS (≤1) with a negative D-dimer result can effectively rule out AAS in athletes, highlighting its potential as a critical diagnostic tool in sports medicine. This approach supports timely and accurate diagnosis, facilitating rapid treatment and potentially reducing complications from misdiagnosed or undiagnosed AAS in athletes.