High-Risk Conditions (each category scored 0 or 1 — not additive within category)

None of the following high-risk conditions+0Marfan syndrome or other connective tissue disorder (Ehlers-Danlos, Loeys-Dietz)+1Family history of aortic disease (aortic aneurysm, dissection, or sudden cardiac death)+1Known aortic valve disease (bicuspid valve, aortic stenosis, or aortic regurgitation)+1Known thoracic aortic aneurysm+1Recent aortic manipulation (surgery, cardiac catheterization, IABP, stenting within 30 days)+1

High-Risk Pain Features (each category scored 0 or 1 — not additive within category)

None of the following high-risk pain features+0Abrupt onset of pain (maximal intensity at onset, 'worst pain ever,' thunderclap quality)+1Severe intensity pain+1Ripping, tearing, sharp, or stabbing character of pain+1

High-Risk Examination Findings (each category scored 0 or 1 — not additive within category)

None of the following high-risk examination findings+0Pulse deficit OR blood pressure differential > 20 mmHg between arms+1New aortic insufficiency murmur (not previously documented)+1Focal neurological deficit combined with chest/back pain+1Hypotension or shock (SBP < 90 mmHg)+1

Aortic Dissection Detection Risk Score (ADD-RS)

Aortic Dissection Detection Risk Score (ADD-RS)