Low and intermediate risk aortic dissection detection risk score and negative D-dimer: a word of caution

Aim A low or intermediate aortic dissection detection risk score coupled with a negative D-dimer has been proposed as a reliable rule-out strategy for acute aortic syndrome (AAS) in the emergency department. Locally, its use has crept into the work-up of patients with suspected AAS. This opinion piece offers a word of caution—the stakes are high for missing AAS. Although the rule-out strategy does show exciting potential, it remains to be validated, especially for Australasian patients. Patients with suspected AAS should continue to be investigated with timely advanced imaging such as contrast-enhanced computed tomographic aortography.‍‍‍