Aortic Dissection Detection Risk Score (ADD-RS)
Risk-stratifies patients with suspected acute aortic dissection (0–3: one point per category of high-risk conditions, pain features and examination findings). A score of 0 alone does not rule out dissection; ADD-RS ≤ 1 with D-dimer < 500 ng/mL had a 0.3 % failure rate (ADvISED).
Score interpretation
ADD-RS 0: low pre-test probability of acute aortic dissection — not low enough on its own to rule it out.
→ May proceed with aortic biomarker (D-dimer) testing per ADD-RS low-risk pathway. CT not mandatory if D-dimer negative.
ADD-RS 1: Intermediate probability. CT aorta required.
→ Urgent CT angiography of aorta (triple rule-out or ECG-gated chest/abdomen/pelvis CT).
ADD-RS 2–3: High probability of acute aortic dissection.
→ Immediate CT aorta. Activate aortic surgery team. BP control (target SBP 100–120 mmHg). Type and cross-match.
Interpretation bands for the ADD-RS. Apply clinical judgement and local guidance.
References
- 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: results from the International Registry of Acute Aortic Dissection. Circulation. 2011;123(20):2213–2218.
- 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(3):250–258.
Related
Curated clinical cross-links plus same-class fallbacks.
- Sodium Nitroprusside · Direct Vasodilator (NO Donor) — Hypertensive Emergency / Aortic Dissection
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- Labetalol (IV — Hypertensive Emergency) · Combined alpha and beta blocker
- Tenecteplase · Cardiovascular Emergency
- Tirofiban · Cardiovascular Emergency
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The ADD-RS is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.