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Introduction Acute aortic syndromes (AASs) are rare and severe cardiovascular emergencies often with non-specific symptoms, leading to diagnostic uncertainty. For AASs, both misdiagnosis and over-testing are key concerns, and standardized diagnostic strategies may help physicians to balance these risks. A diagnostic multi parametric algorithm is proposed via the European Society of Cardiology (ESC). It combines the aortic dissection detection-risk score (ADD-RS) with D-dimer and has been validated with an excellent capacity to rule out AAS. Using an ADD-RS score of ≤1 and negative D-dimer has been found to be 98.8% sensitive to rule out acute aortic dissection.Encouraging the use of this diagnostic algorithm is borne out of desire to reduce patient radiation exposure from a high dose investigation with a low probability of positive findings and optimize the management of patients initially identified as suspected acute aortic dissection (AAD).Aim We aimed to assess the adherence of our trust to the European Society of Cardiology ADD-RS in combination with D-Dimer for investigating patients with suspected AAD.Methods We performed a retrospective analysis of all patients who underwent CT-Aortograms between 15th of June and 15th of September 2024 in our trust.Out of 108 patients, 62 were identified as having a CT-Aortogram to rule out acute aortic dissection. We excluded patients with unreported scans, patients who were scanned for Abdominal Aortic Aneurysm surveillance and those who were scanned after road traffic accidents.We started with demographic analysis; the mean age was 65 (range of 35-87) with females being 52% of the population compared to males which were 48%.We calculated their ADD-RS risk scores and found that 49 patients (79%) were low risk (ADD-RS <2) compared to 13 patients who were high risk (score >=2) as shown in figure 1. All the low-risk group were found to have had an ECG prior to having CT. However, only 28 (57%) had a chest X-Ray. As shown in figure 2 20 patients (42%) had a D-Dimer and 40% of those who had a D-Dimer had a negative result .We reviewed the final diagnosis of all the patients who were suspected AAS; none of which had a proved aortic dissection and found that 42% had a final diagnosis of musculoskeletal chest pain, 19% had a diagnosis of an Non-ST Elevation Myocardial Infarction (NSTEMI) or Angina. 11% had an abdominal cause of their presentation (diverticulitis, cholecystitis or appendicitis) and <10% were patients who were found to have lower respiratory tract infection, heart failure or severe hypertension.Conclusion Amongest patients who presented with an initially suspected diagnosis of AAD, 49 patients (79%) were low risk according to the ADD-RS risk score and among this group, 42% did not get a D-Dimer before having their CT-Aortogram and 40% of those who had a D-Dimer had a negative test result.The data suggests that at least 36 CT aortas requested could have been avoided if the pathway had been utilized, given the absence of positive D-dimer in these low ADD-RS patients.It therefore seems reasonable to conclude that implementing the use of ADD-RS and D-dimer has the potential to considerably reduce the amount of unnecessary CT Aortograms requested, thereby reducing radiation exposure, increasing CT department capacity for more appropriate scans and cutting down on unnecessary investigation costs . Moreover, the use of this pathway could help to narrow down differential diagnoses suspected by clinicians, in order to investigate and treat in a more appropriate and timely manner, ultimately leading to optimal care for patients.Recommendations and Quality Improvement Plan: * We presented these audit results to cardiology, radiology and acute medicine governance meetings.* Stakeholders were allocated to ensure the implementation of the score and to make sure the new team members are aware of how to use it in suspected dissection* We populated the score on our medicine on-call social media groups complying with General Data Protection Regulation (GDPR).* Finally, we are working at the moment to develop a simple pathway including the 3 components of the ADD-RS and the D-Dimer to be incorporated into the clerking booklet.* A poster has been placed in Emergency Department and medical handover rooms as a reminder to all teams.* We aim to re-audit in 3 months.Abstract 45 Figure 1Percentage of patients with low (ADD-RS<2) versus high risk(ADD-RS >=2)Abstract 45 Figure 2Percentage of low risk patients who had a D-Dimer prior to having CT-Aortogram