#EMConf: The YEARS Algorithm
The YEARS Algorithm: A clinical decision tool that incorporates differential D-Dimer cutoff values at presenation, developed to be fast and reduce the number of CTPA investigations
Three YEARS Items:
- clinical signs of DVT
- Is Pulmonary Embolsim the most likely diagnosis?
- Any YEARS items = 500 ng/mL
- No YEARS items = 1000 ng/mL
Study Design: prospective, multi-center, cohort study
- Primary: Number of indepedently adjudicated events of VTE during 3 months of follow up
- Secondary: Number of required CTPA in the YEARS algorithm compared to Well's diagnostic algorithm
Exclusions: 1. Age < 18 2. Initiation of therapeutic anticoagulation 24 hours or more before evaluation 3. Life expectancy < 3 months 4. Pregnancy 5. Allergy to IV contrast
- 3465 patients were assessed of whom 456 (13%) were diagnosed with pulmonary embolism at baseline
- Of the 2946 (85%) patients who pulmonary embolism were ruled out at baseline and remained untreated, 18 patients were diagnosed with symptomatic VTE during 3 month follow up, of whom, six had fatal pulmonary embolism
- CTP was ont indicated in 1651 patients (48%) with the YEARS algorithm compared with 1174 (34%) of patients, if Wells rule and fixed D-Dimer threshold of less than 500 would have been applied
Author's Conclusion: The use of YEARS diagnostic algorithm can safely exclude patients with suspected PE and may decrease use of CTPA studies as compared to Wells' criteria
- Age adjusted D-Dimer (defined as age * 10 in patients > 50 years) has been prospectively validated to be safe and reduce the number of CTPA in patients low risk for PE
- if age adjusted D-Dimer was applied, the YEARS algorithm would have led to an absolute reduction of CTPA by only 8.7% compared to 14% as the study showed.
References: Van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet. 2017; Van der Pol LM, Van der Hulle T, Cheung YW, et al. No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonary embolism. J Thromb Haemost. 2017;15(12):2317-2324. Righini M, Van es J, Den exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014;311(11):1117-24.