The Need for Speed! The SPEED Protocol to Detect Aortic Dissection
- Nov 11
- 2 min read
EMUGs Journal Club - November 2025
Hosted and Summarised by Dr Brian Doyle, FACEM FACEP
The SPEED protocol included three views:
- A parasternal long-axis view
- Transverse and sagittal views of the abdominal aorta
Three sonographic findings were considered consistent with aortic dissection:
1. The presence of an intimal flap
2. A pericardial effusion
3. Dilation of the aortic outflow tract greater than 35 mm
POCUS was performed by PGY1–3 EM residents who underwent training and were
supervised by attending physicians. All patients received a gold-standard imaging test (CTA,
MRA, or TOE).
Results?
It took them ten years to get an answer—wow!
Across 1,314 POCUS scans, the SPEED protocol detected 41 of 44 confirmed dissections,
giving a sensitivity of 93.2% (95% CI 81–98) and specificity of 90%.
The authors emphasized that “it is important to recognize that the SPEED protocol cannot
exclude aortic dissection. [We] advocate for its use to expedite the diagnosis and
management of dissection.”
At our EMUGs Journal Club, discussion focused on the study’s limitations including
external validity—it was performed within a single US health system, and as with POCUS
applications, results are highly operator-dependent.
Participants also explored additional ultrasound views that could aid diagnosis, including
suprasternal and right parasternal views, assessment for aortic regurgitation, and the
presence of clots within the pericardium as potential clues.
There was lively discussion about how to integrate this exam into clinical practice,
emphasizing the importance of combining ultrasound findings with clinical suspicion and
D-dimer testing. For further guidance, check out the Aortic Dissection Detection Risk
Score (ADD-RS) on MDCalc.
And of course, EMUGs members shared a few memorable stories of picking up dissections
in the wild. We’ve got the need for SPEED!
Reference:
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