Guide de pratique canadien sur le dx des syndromes aortiques aigus

Ohle R, Yan JW, Yadav K, Cournoyer A, Savage DW, Jetty P, Atoui R, Bittira B, Wilson B, Gupta A, Coffey N, Callaway Y, Middaugh J, Ansell D, Rubens F, Bignucolo SJ, Scott TM, McIsaac S, Lang E. Diagnosing acute aortic syndrome: a Canadian clinical practice guideline. CMAJ. 2020 Jul 20;192(29):E832-E843. doi: 10.1503/cmaj.200021. PMID: 32690558; PMCID: PMC7828987.

KEY POINTS 

• This clinical practice guideline recommends that providers routinely evaluate any patient presenting with complaints that may represent acute aortic syndrome (AAS) to establish a pretest risk of disease that can then be used to guide diagnostic decisions. 

• Establishing a pretest risk of disease includes specific questions about risk factors and pain features, as well as a focused examination to identify findings that are associated with AAS. 

• No further testing is suggested in those without any risk factors, pain features and findings on physical examination associated with AAS. 

• In those with a moderate risk for AAS, a normal result of D-dimer testing is reasonable to reduce probability of AAS; in patients with a low or high probability of the condition, the use of D-dimer is not recommended. 

• Expedited electrocardiogram-gated computed tomography of the aorta is recommended in those with a high probability for AAS.