MDCalc

YEARS Algorithm for Pulmonary Embolism (PE)

Helps rule out pulmonary embolism (PE) in adult pregnant and non-pregnant patients.

Pregnant patient

YEARS items

Clinical signs of DVT

Result:

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Advice
  • Use this clinical decision tool as an adjunct to clinical judgment and evaluation in the appropriate patient for whom you are considering PE as a diagnosis. 
  • If the YEARS algorithm rules out PE, no further workup for PE is recommended. 
  • If the YEARS algorithm is unable to exclude PE, proceed with CTPA (or V/Q scan in patients where CTPA is contraindicated, such as those with iodinated contrast allergy, significant renal insufficiency, or in pregnant patients where minimizing radiation exposure to the fetus is preferred). 
  • If there are clinical signs of DVT in the pregnant population, obtain compression ultrasonography of the indicated leg first.

Management

  • If PE is confirmed by CTPA, initiate anticoagulation after evaluation of patient risk. 

  • If PE is ruled out by the YEARS algorithm, continue your clinical evaluation and workup for other diagnoses as indicated.

Critical Actions

  • Do NOT use this tool in hemodynamically unstable patients. 

  • Consider bleeding risk before initiating anticoagulation in patients found to have venous thromboembolism (VTE). 

  • Ensure that the appropriate D-dimer threshold is being used, depending on both the number of positive criteria and the units used by your institution.

  • Use your clinical judgment when using the tool and considering its results.

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