What does ADD-RS stand for?

ADD-RS stands for Aortic Dissection Detection Risk Score. It was derived and validated to quantify the pre-test probability of acute aortic dissection using three clinical domains.

Does a score of 0 rule out aortic dissection?

No. A score of 0 indicates low pre-test probability but does not exclude dissection. Current guidelines suggest combining an ADD-RS of 0 with a negative D-dimer to safely exclude dissection in appropriate patients.

How is each domain scored?

Each domain (conditions, pain, exam) is scored 0 or 1. Even if multiple findings within one domain are positive, that domain still contributes only 1 point. The total ranges from 0 to 3.

What imaging is recommended for high-risk patients?

Patients with ADD-RS of 2 or 3 typically warrant immediate CT angiography of the chest, abdomen, and pelvis without waiting for D-dimer results. Clinical judgment and hemodynamic stability guide the exact approach.

Is this tool a replacement for clinical judgment?

No. ADD-RS is a decision aid designed to supplement — not replace — clinical judgment. It should be interpreted in the full context of the patient presentation, history, and institutional protocols.

Can this be used for chronic aortic dissection?

ADD-RS was validated for acute aortic dissection presenting to the emergency department. It is not validated for chronic dissection or post-operative monitoring.

Aortic Dissection Risk Score (ADD-RS)

Name: Aortic Dissection Risk Score (ADD-RS)
Availability: InStock
Author: Nham Vu

Score 3 clinical domains (high-risk conditions, pain features, exam findings) to estimate the pre-test probability of acute aortic dissection.

Summary

Score 3 clinical domains (high-risk conditions, pain features, exam findings) to estimate the pre-test probability of acute aortic dissection.

How it works

Review the patient for any high-risk predisposing conditions (Marfan syndrome, aortic disease history, recent aortic manipulation, or known aortic aneurysm).
Assess pain characteristics: sudden onset, severe or tearing/ripping quality, or radiation to the back, abdomen, or jaw.
Examine the patient for pulse or blood pressure differential, focal neurological deficit, or aortic regurgitation murmur.
Each domain that has at least one positive finding contributes 1 point — maximum total score is 3.
A score of 0 is low risk, 1 is intermediate risk, and 2 or 3 is high risk for acute aortic dissection.
Use the score alongside clinical judgment; low-risk patients may benefit from D-dimer testing per institutional protocol.

Use cases

Emergency physicians evaluating chest or back pain of unclear origin.
Rapid risk stratification before ordering CT angiography.
Combined use with D-dimer in low-probability patients to safely rule out dissection.
Teaching tool for residents learning systematic evaluation of suspected aortic emergencies.
Pre-transfer triage decisions when advanced imaging is not immediately available.
Documentation of clinical reasoning in high-acuity chest pain workups.

Frequently Asked Questions

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Last updated: 2026-05-23 · Reviewed by Nham Vu