D-dimers in the emergency department evaluation of aortic dissection.

UNLABELLED: 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 micro g/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.