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Abstract：
OBJECTIVE: To evaluate the diagnostic accuracy of the aortic dissection detection risk score (ADD-RS) used alone or in combination with D-dimer for detecting acute aortic syndrome (AAS) in patients presenting with symptoms suggestive of AAS.
METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2024. Additionally, the reference lists of included studies and other systematic reviews were thoroughly searched. All diagnostic accuracy studies that assessed the use of ADD-RS alone or with D-Dimer for diagnosing AAS compared with a reference standard test (e.g. computer tomographic angiography (CTA), ECG-gated CTA, echocardiography, magnetic resonance angiography, operation, or autopsy) were included. Two reviewers independently selected and extracted data. Risk of bias was appraised using QUADAS-2 tool. Data were synthesised using hierarchical meta-analysis models.
RESULTS: We selected 13 studies from the 2017 citations identified, including six studies evaluating combinations of ADD-RS alongside D-dimer>500ng/L. Summary sensitivities and specificities (95% credible interval) were: ADD-RS>0 94.6% (90%, 97.5%) and 34.7% (20.7%, 51.2%), ADD-RS>1 43.4% (31.2%, 57.1%) and 89.3% (80.4%, 94.8%); ADD RS>0 or D-Dimer>500ng/L 99.8% (98.7%, 100%) and 21.8% (12.1%, 32.6%); ADD RS>1 or D-Dimer>500ng/L 98.3% (94.9%, 99.5%) and 51.4% (38.7%, 64.1%); ADD RS>1 or ADD RS = 1 with D-dimer>500ng/L 93.1% (87.1%, 96.3%) and 67.1% (54.4%, 77.7%).
CONCLUSIONS: Combinations of ADD-RS and D-dimer can be used to select patients with suspected AAS for imaging with a range of trade-offs between sensitivity (93.1% to 99.8%) and specificity (21.8% to 67.1%).
METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2024. Additionally, the reference lists of included studies and other systematic reviews were thoroughly searched. All diagnostic accuracy studies that assessed the use of ADD-RS alone or with D-Dimer for diagnosing AAS compared with a reference standard test (e.g. computer tomographic angiography (CTA), ECG-gated CTA, echocardiography, magnetic resonance angiography, operation, or autopsy) were included. Two reviewers independently selected and extracted data. Risk of bias was appraised using QUADAS-2 tool. Data were synthesised using hierarchical meta-analysis models.
RESULTS: We selected 13 studies from the 2017 citations identified, including six studies evaluating combinations of ADD-RS alongside D-dimer>500ng/L. Summary sensitivities and specificities (95% credible interval) were: ADD-RS>0 94.6% (90%, 97.5%) and 34.7% (20.7%, 51.2%), ADD-RS>1 43.4% (31.2%, 57.1%) and 89.3% (80.4%, 94.8%); ADD RS>0 or D-Dimer>500ng/L 99.8% (98.7%, 100%) and 21.8% (12.1%, 32.6%); ADD RS>1 or D-Dimer>500ng/L 98.3% (94.9%, 99.5%) and 51.4% (38.7%, 64.1%); ADD RS>1 or ADD RS = 1 with D-dimer>500ng/L 93.1% (87.1%, 96.3%) and 67.1% (54.4%, 77.7%).
CONCLUSIONS: Combinations of ADD-RS and D-dimer can be used to select patients with suspected AAS for imaging with a range of trade-offs between sensitivity (93.1% to 99.8%) and specificity (21.8% to 67.1%).
摘要：
目的：评价主动脉夹层检测风险评分（ADD-RS）单独或联合D-二聚体检测急性主动脉综合征（AAS）的准确性。
方法：我们搜索了MEDLINE，EMBASE,和Cochrane图书馆从成立到2024年2月。此外,彻底检索了纳入研究的参考清单和其他系统综述。与参考标准测试（例如，计算机断层血管造影（CTA），心电门控CTA,超声心动图,磁共振血管造影术,操作,或尸检）被包括在内。两名审阅者独立选择和提取数据。使用QUADAS-2工具评估偏倚风险。使用层次元分析模型综合数据。
结果：我们从2017年确定的引文中选择了13项研究，包括六项评估ADD-RS与D-二聚体>500ng/L的组合的研究。汇总敏感性和特异性(95%可信区间)为:ADD-RS>094.6%(90%，97.5%）和34.7%（20.7%，51.2%），ADD-RS>143.4％（31.2％，57.1%)和89.3%(80.4%，94.8%);ADDRS>0或D-二聚体>500ng/L99.8%(98.7%,100%)和21.8%(12.1%，32.6%);ADDRS>1或D-二聚体>500ng/L98.3%(94.9%,99.5%）和51.4%（38.7%，64.1%)；ADDRS>1或ADDRS=1，D-二聚体>500ng/L93.1%(87.1%，96.3%）和67.1%（54.4%，77.7%）。
结论：ADD-RS和D-二聚体的组合可用于选择可疑AAS患者进行成像，在敏感性（93.1％至99.8％）和特异性（21.8％至67.1％）之间进行权衡。
方法：我们搜索了MEDLINE，EMBASE,和Cochrane图书馆从成立到2024年2月。此外,彻底检索了纳入研究的参考清单和其他系统综述。与参考标准测试（例如，计算机断层血管造影（CTA），心电门控CTA,超声心动图,磁共振血管造影术,操作,或尸检）被包括在内。两名审阅者独立选择和提取数据。使用QUADAS-2工具评估偏倚风险。使用层次元分析模型综合数据。
结果：我们从2017年确定的引文中选择了13项研究，包括六项评估ADD-RS与D-二聚体>500ng/L的组合的研究。汇总敏感性和特异性(95%可信区间)为:ADD-RS>094.6%(90%，97.5%）和34.7%（20.7%，51.2%），ADD-RS>143.4％（31.2％，57.1%)和89.3%(80.4%，94.8%);ADDRS>0或D-二聚体>500ng/L99.8%(98.7%,100%)和21.8%(12.1%，32.6%);ADDRS>1或D-二聚体>500ng/L98.3%(94.9%,99.5%）和51.4%（38.7%，64.1%)；ADDRS>1或ADDRS=1，D-二聚体>500ng/L93.1%(87.1%，96.3%）和67.1%（54.4%，77.7%）。
结论：ADD-RS和D-二聚体的组合可用于选择可疑AAS患者进行成像，在敏感性（93.1％至99.8％）和特异性（21.8％至67.1％）之间进行权衡。
