Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection

Publication Date: October 1, 2014
Last Updated: March 14, 2022

Recommendations

In an attempt to identify patients at very low risk for acute nontraumatic thoracic aortic dissection, do not use existing clinical decision rules alone. The decision to pursue further workup for acute nontraumatic aortic dissection should be at the discretion of the treating physician. (C)
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In adult patients with suspected nontraumatic thoracic aortic dissection, do not rely on D-dimer alone to exclude the diagnosis of aortic dissection. (C)
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In adult patients with suspected nontraumatic thoracic aortic dissection, emergency physicians may use CTA to exclude thoracic aortic dissection because it has accuracy similar to that of TEE and MRA. (B)
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In adult patients with suspected nontraumatic thoracic aortic dissection, do not rely on an abnormal bedside TTE result to definitively establish the diagnosis of thoracic aortic dissection. (B)
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In adult patients with suspected nontraumatic thoracic aortic dissection, immediate surgical consultation or transfer to a higher level of care should be considered if a TTE is suggestive of aortic dissection. (Consensus recommendation) (C)
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In adult patients with acute nontraumatic thoracic aortic dissection, decrease blood pressure and pulse if elevated. However, there are no specific targets that have demonstrated a reduction in morbidity and mortality. (C)
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Recommendation Grading

Overview

Title

Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection

Authoring Organization

American College of Emergency Physicians

Publication Month/Year

October 1, 2014

Last Updated Month/Year

July 31, 2023

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This clinical policy from the American College of Emergency Physicians addresses key issues in the evaluation and management of patients with suspected acute nontraumatic thoracic aortic dissection.

Target Patient Population

Patients with suspected acute non traumatic thoracic aortic dissection

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Emergency care

Intended Users

Nurse, nurse practitioner, paramedic emt, physician, physician assistant

Scope

Assessment and screening, Management

Diseases/Conditions (MeSH)

D001018 - Aortic Diseases, D001019 - Aortic Rupture

Keywords

aortic dissection, nontraumatic, thoracic

Source Citation

Ann Emerg Med. 2015;65:32-42

Methodology

Number of Source Documents
56
Literature Search Start Date
January 1, 2000
Literature Search End Date
May 3, 2012