D-dimers in the emergency department evaluation of aortic dissection

Aortic dissection (AD) is the most common acute aortic condition requiring urgent surgery. AD, if not diagnosed in the emergency department (ED), is frequently fatal. AD is a difficult antemortem diagnosis. Objectives: To determine if acute AD is associated with an elevation of fibrin degradation products, D-dimers. Methods: This was a retrospective chart review of patients diagnosed as having AD in the ED in whom a D-dimer determination was obtained in the ED, prior to any therapeutic intervention. The study was conducted in an urban Level I trauma center between October 1996 and September 2000. Exclusion criteria were referred patients with known diagnosis of AD. The D-dimer assay used was the semiquantitative latex agglutination assay, with a normal range up to 0.5 mug/mL. Results: One hundred fifty-six patients were diagnosed as having AD in the ED. Seven patients had a D-dimer assay during their workup. All seven had a positive test. Conclusions: All seven patients with an AD who had D-dimer assays performed in the ED had positive results by latex agglutination.