YEARS Algorithm for Pulmonary Embolism (PE)
INSTRUCTIONS
Use in hemodynamically stable patients ≥18 years old.
- Hemodynamically stable patients ≥18 years old with clinically suspected acute pulmonary embolism (PE).
- Note: this study included patients with suspected acute PE in both inpatient and outpatient settings.
- Note that the original study did not include patients who:
- Were treated with therapeutic doses of anticoagulants initiated 24 hours or more before eligibility assessment.
- Have a life expectancy less than 3 months or geographic inaccessibility precluding follow up.
- Have an allergy to intravenous contrast agent.
- Consists of the three most predictive criteria of the Wells' Score for PE: clinical signs of deep vein thrombosis (DVT), hemoptysis, and whether PE is the most likely diagnosis.
- Also incorporates variable D-dimer thresholds, depending on the number of criteria fulfilled.
- In patients with no YEARS items and D-dimer <1,000 ng/mL, or with one or more YEARS items and D-dimer <500 ng/mL, PE was considered excluded. All other patients had CT pulmonary angiogram (CTPA).
- Reduces use of CTPA by 14% compared with the current standard algorithm (absolute reduction) and by 8.7% compared with the age-adjusted D-dimer threshold, such that patients younger than 50 years also benefit from the YEARS algorithm.
- Provides for simple and efficient diagnostic management of patients with suspected PE, and is more compatible with the demands of clinical practice.
- Reduces false positives, overdiagnosis, and overutilization of CTPA investigations in all age groups, in addition to reducing unnecessary exposure to ionizing radiation.
Result:
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About the Creator
Tom van der Hulle, MD, is an internist in the department of thrombosis and hemostasis at Leiden University Medical Centre in Leiden, Netherlands. His primary research interests involve hematology, oncology, and pulmonology.
To view Dr. Tom van der Hulle's publications, visit PubMed
About the Creator
Menno Huisman, MD, PhD, FESC, is a professor of medicine in the department of medicine - thrombosis and hemostasis at Leiden University Medical Center in The Netherlands. He is an internist with specialty in cardiovascular medicine. Dr. Huisman’s primary research is focused on the clinical diagnosis and treatment of venous and arterial thromboembolic disorders.
To view Dr. Menno Huisman's publications, visit PubMed