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YEARS Algorithm for Pulmonary Embolism (PE)
Simplified diagnostic algorithm using three clinical items and an adapted D-dimer cut-off to rule out suspected PE.
YEARS Algorithm for Pulmonary Embolism (PE)
Clinical signs of deep vein thrombosis (leg swelling, asymmetric pain)
Haemoptysis
Pulmonary embolism is the most likely diagnosis
D-dimer
ng/mL FEU
Complete the fields above to see the result.
When to use
- Adults with clinically suspected acute pulmonary embolism, as a front-line strategy to reduce unnecessary CT pulmonary angiography.
- Combining three simple bedside items with a single D-dimer measurement to decide whether imaging can be safely deferred.
Formula
Count the YEARS items present (clinical signs of DVT, haemoptysis, PE most likely diagnosis; 0–3). If 0 items are present, PE is excluded when D-dimer <1000 ng/mL FEU; if ≥1 item is present, PE is excluded when D-dimer <500 ng/mL FEU. Otherwise CT pulmonary angiography is required.
Pearls and pitfalls
- In the original prospective cohort, using this algorithm let CTPA be safely withheld in 48% of patients, 14% more than a fixed 500 ng/mL Wells-based strategy, with a 3-month VTE failure rate of 0.61%.
- A pregnancy-adapted version of the algorithm has been separately validated in pregnant patients with suspected PE.