Nontraumatic Thoracic Aortic Dissection (2014)

• Inclusion: Adult ≥ 18 with suspected acute nontraumatic thoracic aortic dissection
• Exclusion: Traumatic aortic dissection, pediatric, pregnant
• Level A: None
• Level B:
  • CTA to exclude thoracic aortic dissection (accuracy similar to that of TEE and MRA).
  • Do not rely on abnormal bedside TTE result to definitively establish diagnosis
• Level C:
  • Do not use clinical decision rules alone to identify very low risk acute thoracic aortic dissection. Decision to pursue further work up discretion of EP.
  • Do not rely on d-dimer alone to exclude the diagnosis of aortic dissection
  • Immediate surgical consultation or transfer to higher level of care if TTE suggestive or dissection
  • Decrease BP and pulse if elevated. No specific targets.

ACEP Clinical Policy: Critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. PDF