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    YEARS Algorithm for Pulmonary Embolism (PE)

    Helps rule out pulmonary embolism; also validated in pregnant patients.
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    INSTRUCTIONS

    Use in hemodynamically stable patients ≥18 years old.

    When to Use
    Pearls/Pitfalls
    Why Use
    • 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.
    • 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.
    No
    Yes
    YEARS items
    No
    Yes
    No
    Yes
    No
    Yes

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    Evidence
    Creator Insights

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    • PE was excluded (and CTPA deemed unnecessary) in patients who who fell below the D-dimer thresholds set by the YEARS algorithm.
    • 3-month incidence of venous thromboembolism (VTE) of patients who did not undergo CTPA was 0.43%. This is similar to the traditional two-tier Wells' Score (0.34%).
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    About the Creator
    Dr. Tom van der Hulle
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