Pulmonary embolism
YEARS algorithm
YEARS (van der Hulle 2017) asks three questions: clinical signs of DVT, haemoptysis, and whether PE is the most likely diagnosis. With none present, a D-dimer below 1000 µg/L excludes PE; with one or more, the threshold is 500 µg/L. Everyone else has CTPA. It avoided CTPA in 14% more patients than the Wells strategy with the same safety. The pregnancy-adapted version (Artemis) starts with compression ultrasound when DVT signs are present.
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YEARS items
Tap every item that is present
D-dimer
Measured in every patient
YEARS items: 0 · D-dimer cut-off 1000 µg/L
< 1000
D-dimer that excludes PE
No YEARS item: the higher 1000 µg/L threshold applies
Decision guide
- Who YEARS applies toHaemodynamically stable patients with suspected PE, all levels of probability, D-dimer measured in everyone. Haemodynamic instability → bedside echo / CTPA pathway instead.
YEARS avoided CTPA in 48% of patients (vs 34% with Wells and a fixed cut-off), with 0.61% VTE at 3 months among those not imaged.
References
- van der Hulle T, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017;390:289-297.
- van der Pol LM, et al. Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism (Artemis). N Engl J Med 2019;380:1139-1149.
- Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J 2020;41:543-603.
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