The diagnosis and management of acute thoracic aortic dissection in the ED are challenging. For many reasons, this disease is very difficult to study in randomized controlled trials that might elucidate clearer diagnostic or management pathways. This clinical policy reflects the quality of the literature on this topic and therefore the lack of Level A recommendations that can be made on the management of these patients.
Explore This IssueACEP Now: Vol 34 – No 05 – May 2015
Editor’s Note: The print version of this article omitted the recommendations for critical questions 4 and 5. This version has been updated to include those recommendations.
Dr. Fredericks is an emergency medicine resident physician at the University of Texas Southwestern in Dallas.
Dr. Diercks is professor of emergency medicine and chair of the department of emergency medicine at the University of Texas Southwestern.
Translation of Classes of Evidence to Recommendation Levels
Strength of recommendations regarding each critical question were made by subcommittee members using results from strength-of-evidence grading, expert opinion, and consensus among subcommittee members according to the following guidelines:
Level A recommendations.
Generally accepted principles for patient care that reflect a high degree of clinical certainty (ie, based on evidence from one or more Class of Evidence I or multiple Class of Evidence II studies).
Level B recommendations.
Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (ie, based on evidence from one or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).
Level C recommendations.
Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of any adequate published literature, based on expert consensus. In instances where consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.
- Diercks DB, Promes SB, Schuur JD, et al. Clinical policy: critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. Ann Emerg Med. 2015;65(1):32-42.e12.