ADD-RS Calculator

Clinical Application of ADD-RS (ESC 2024)

The Aortic Dissection Detection Risk Score (ADD-RS) standardizes risk stratification in suspected acute aortic syndrome (AAS). A maximum of 1 point is allocated per category (Total score 0 to 3):

• 1. High-risk condition: Marfan syndrome / aortopathy, family history of aortic dissection, aortic valve disease, prior aortic manipulation, or known thoracic aneurysm.
• 2. High-risk pain feature: Abrupt onset, severe ripping/tearing intensity, migrating character (chest, interscapular, abdominal).
• 3. High-risk examination feature: Perfusion deficit (pulse differential or systolic BP difference > 20 mmHg), focal neurological deficit, new aortic regurgitation murmur, or hypotension/shock.

Diagnostic Workflow Algorithm (ESC 2024)

Following ECG exclusion of acute STEMI:

• Score ≥ 2 (High Risk): Urgent CTA of the entire aorta without delay. Do not await D-dimer results.
• Score 0–1 (Low to Intermediate Risk): Triaged with D-dimer, POCUS (focused cardiac and aortic ultrasound), and chest radiography. A negative D-dimer (< 500 ng/mL) combined with negative POCUS delivers > 99% negative predictive value to safely rule out AAS.