The YEARS criteria is a diagnostic algorithm that determines the risk of pulmonary embolism (PE) derived from three items in the Wells score that are most predictive of PE 1. Unlike the Wells score, it uses a variable D-dimer threshold based off clinical pre-test probability. The YEARS criteria is efficient and non-complex when compared to other diagnostic tools for PE, making it useful in clinical practice 1.
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Criteria
does the patient have clinical signs or symptoms of deep vein thrombosis (DVT)?
does the patient have hemoptysis?
is PE the most likely diagnosis?
Application
If a patient has 0 YEARS items - use a D-dimer threshold of 1000 ng/mL.
If a patient has 1+ YEARS items - use a D-dimer threshold of 500 ng/mL.
Interpretation
0 YEARS items and D-dimer <1000 ng/mL - PE is considered excluded.
1+ YEARS items and a D-dimer <500 mg/mL - PE is considered excluded.
All other patients require a CTPA to exclude PE.
Practical Points
Due to the binary D-dimer threshold used in YEARS, there is an absolute reduction in CTPAs performed across all ages by 14% when compared to the Wells criteria 1,2, and by 8.7% when compared to age-adjusted 1. This is a benefit for younger patients in whom exposure to unnecessary radiation has a more significant lifetime risk 3.
Importantly, the algorithm was not associated with an increase in missed clinically significant PEs 1,4.
Pregnancy adapted YEARS criteria
A pregnancy adapted YEARS criteria is one of the few tools for risk stratification of PE in pregnancy 5-7. It uses the same items and variable D-dimer threshold, with the addition of a compression ultrasonogram in pregnant patients with signs of DVT. If there is evidence of DVT on ultrasound, patients are treated as having a PE without further diagnostic imaging.
The tool produces an absolute reduction in CT scans by 11% when compared to other strategies 5,6.