Aortic dissection is an uncommon but important cause of chest pain in the ED.
The classic presentation of severe (sudden onset, tearing/ripping chest pain that radiates to the back) 9 and the absence of these features is not associated with a significant negative likelihood ratio. As a result diagnosis requires a high degree of suspicion.
For patients determined to be low risk by the AHA aortic dissection risk stratification score, a negative D-dimer confers a negative likelihood ratio of 0.05 (CI 0.02-0.09). Clinicians may consider using D-dimer in the appropriate patient population to further assess their risk for dissection.