Objective To investigate the value of aortic dissection detection (ADD) risk score in the diagnosis of acute aortic syndromes (AAS). Methods Three hundred and forty-two patients with acute chest pain or back pain admitted to the Department of Emergency of the First Affiliated Hospital of Xiamen University from January 2013 to April 2016 were enrolled. At last, 71 patients were definitely diagnosed as AAS (AAS group), and 271 cases were diagnosed as non-AAS (non-AAS group). Furthermore, according to the ADD risk score, they were subdivided into two groups: low-risk (ADD score ≤ 1) and high risk (ADD score >1) subgroups. In the two groups, the ADD risk indexes and the proportions of patients with different risk scores were observed; the receiver operating characteristic curve (ROC curve) was drawn to evaluate the value of ADD risk score for diagnosing AAS. Results Compared with the non-AAS group, the proportions of patients in AAS group with indicators of high-risk pain characteristics, such as sudden pain and laceration-like pain were increased significantly [83.1% (59/71) vs. 31.0% (84/271), 29.6% (21/71) vs. 0 (0/271)];meanwhile, the proportions of patients with high-risk physical examination indicators, such as systolic blood pressure differences among the 4 extremities and the defect of local nerve function in AAS group were also significantly increased [23.9% (17/71) vs. 0 (0/271), 11.3% (8/71) vs. 0 (0/271), both P < 0.05]; the proportion of patients with high risk AAS score in AAS group was higher than that in the non-AAS group [66.2% (47/71) vs. 1.5% (4/271), P < 0.01]. The sensitivity of ADD score ≥ 1 for diagnosis of AAS and area under ROC curve (AUC) were all higher than those of ADD score ≥2 (sensitivity: 98.6% vs. 66.2%, AUC: 0.819 vs. 0.564), moreover, the specificity and the positive predictive value of ADD score ≥ 2 for diagnosis of AAS were higher than those of ADD score ≥ 1 (98.5% vs. 59.8%, 92.2% vs. 39.1%respectively). When the ADD risk score ≥ 1, its odds ratio (OR) = 104.0, 95% confidence interval (CI) was 0.761-0.877, P = 0.000; while ADD risk score ≥ 2, OR = 130.7, 95%CI was 0.516-0.612, P = 0.003. Conclusion It is shown that when ADD risk score (> 1) is used to diagnose AAS, it has relatively high sensitivity, when ADD score being high risk (> 1 score) is applied to diagnose AAS, its specificity is high, thus ADD risk score has important value in helping the early diagnosis of AAS.