{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:35:14Z","timestamp":1792658114192,"version":"4.5.0"},"reference-count":46,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,1,24]],"date-time":"2018-01-24T00:00:00Z","timestamp":1516752000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Acute aortic dissection is a life\u2010threatening condition due to a tear in the aortic wall. It is difficult to diagnose and if missed carries a significant mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a librarian\u2010assisted systematic review of PubMed, MEDLINE, Embase, and the Cochrane database from 1968 to July 2016. Titles and abstracts were reviewed and data were extracted by two independent reviewers (agreement measured by kappa). Studies were combined if low clinical and statistical heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0&lt;\u00a030%). Study quality was assessed using the QUADAS\u20102 tool. Bivariate random effects meta analyses using Revman 5 and SAS 9.3 were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 792 records: 60 were selected for full text review, nine studies with 2,400 participants were included (QUADAS\u20102 low risk of bias, \u03ba\u00a0= 0.89 [for full\u2010text review]). Prevalence of aortic dissection ranged from 21.9% to 76.1% (mean\u00a0\u00b1\u00a0SD\u00a0= 39.1%\u00a0\u00b1\u00a017.1%). The clinical findings increasing probability of aortic dissection were 1) neurologic deficit (\n                      <jats:italic>n\u00a0=<\/jats:italic>\n                      \u00a03, specificity\u00a0= 95%, positive likelihood ratio [LR+]\u00a0= 4.4, 95% confidence interval [CI]\u00a0= 3.3\u20135.7, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0= 0%) and 2) hypotension (\n                      <jats:italic>n\u00a0=<\/jats:italic>\n                      \u00a04, specificity\u00a0= 95%, LR+\u00a0= 2.9 95% CI\u00a0= 1.8\u20134.6, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0= 42%), and decreasing probability were the absence of a widened mediastinum (\n                      <jats:italic>n\u00a0=<\/jats:italic>\n                      \u00a04, sensitivity\u00a0= 76%\u201095%, negative likelihood ratio [LR\u2013]\u00a0= 0.14\u20130.60, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0= 93%) and an American Heart Association aortic dissection detection (AHA ADD) risk score\u00a0&lt;\u00a01 (\n                      <jats:italic>n\u00a0=<\/jats:italic>\n                      \u00a01, sensitivity\u00a0= 91%, LR\u2013\u00a0= 0.22, 95% CI\u00a0= 0.15\u20130.33).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Suspicion for acute aortic dissection should be raised with hypotension, pulse, or neurologic deficit. Conversely, a low AHA ADD score decreases suspicion. Clinical gestalt informed by high\u2010 and low\u2010risk features together with an absence of an alternative diagnosis should drive investigation for acute aortic dissection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.13360","type":"journal-article","created":{"date-parts":[[2017,12,18]],"date-time":"2017-12-18T23:46:39Z","timestamp":1513640799000},"page":"397-412","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta\u2010analysis"],"prefix":"10.1111","volume":"25","author":[{"given":"Robert","family":"Ohle","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Ottawa Hospital Research Institute University of Ottawa Ottawa Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hashim Khaliq","family":"Kareemi","sequence":"additional","affiliation":[{"name":"Department of 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