Years criteria for pulmonary embolism
Citation, DOI, disclosures and article data
At the time the article was created Samantha O’Dempsey had no recorded disclosures.View Samantha O’Dempsey's current disclosures
At the time the article was last revised Craig Hacking had no recorded disclosures.View Craig Hacking's current disclosures
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 PE1. 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 practice1.
On this page:
- Does the patient have clinical signs or symptoms of deep vein thrombosis (DVT)?
- Does the patient have hemoptysis?
- Is PE the most likely diagnosis?
If a patient has 0 YEARS items - use a D-dimer threshold of 1000ng/mL.
If a patient has 1+ YEARS items - use a D-dimer threshold of 500ng/mL.
0 YEARS items and D-dimer <1000ng/mL - PE is considered excluded.
1+ YEARS items and a D-dimer <500mg/mL - PE is considered excluded.
All other patients require a CTPA to exclude PE.
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 pregnancy5-7. 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 current strategies 5,6.
- 1. van der Hulle T, Cheung WY, Kooij S, Beenen LFM, van Bemmel T, van Es J, Faber LM, Hazelaar GM, Heringhaus C, Hofstee H, Hovens MMC, Kaasjager KAH, van Klink RCJ, Kruip MJHA, Loeffen RF, Mairuhu ATA, Middeldorp S, Nijkeuter M, van der Pol LM, Schol-Gelok S, Ten Wolde M, Klok FA, Huisman MV. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. (2017) Lancet (London, England). 390 (10091): 289-297. doi:10.1016/S0140-6736(17)30885-1 - Pubmed
- 2. Kabrhel C, Van Hylckama Vlieg A, Muzikanski A, Singer A, Fermann GJ, Francis S, Limkakeng A, Chang AM, Giordano N, Parry B. Multicenter Evaluation of the YEARS Criteria in Emergency Department Patients Evaluated for Pulmonary Embolism. (2018) Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 25 (9): 987-994. doi:10.1111/acem.13417 - Pubmed
- 3. Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. (2007) JAMA. 298 (3): 317-23. doi:10.1001/jama.298.3.317 - Pubmed
- 4. van der Pol LM, Bistervels IM, van Mens TE, van der Hulle T, Beenen LFM, den Exter PL, Kroft LJM, Mairuhu ATA, Middeldorp S, van Werkhoven JM, Ten Wolde M, Huisman MV, Klok FA. Lower prevalence of subsegmental pulmonary embolism after application of the YEARS diagnostic algorithm. (2018) British journal of haematology. 183 (4): 629-635. doi:10.1111/bjh.15556 - Pubmed
- 5. van der Pol LM, Tromeur C, Bistervels IM, Ni Ainle F, van Bemmel T, Bertoletti L, Couturaud F, van Dooren YPA, Elias A, Faber LM, Hofstee HMA, van der Hulle T, Kruip MJHA, Maignan M, Mairuhu ATA, Middeldorp S, Nijkeuter M, Roy PM, Sanchez O, Schmidt J, Ten Wolde M, Klok FA, Huisman MV. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. (2019) The New England journal of medicine. 380 (12): 1139-1149. doi:10.1056/NEJMoa1813865 - Pubmed
- 6. Al Oweidat K, Al Ryalat SA, Al Husban N, Alhawari H, Ghareeb R, Ribie M, Jwaied S, Al Yasjeen S, Juweid ME. Additive evidence of the competence of pregnancy-adapted YEARS algorithm in reducing the need for CTPA, Q and/or V/Q scintiscan. (2020) Hellenic journal of nuclear medicine. 23 (2): 165-172. doi:10.1967/s002449912106 - Pubmed
- 7. Van der Pol LM, Mairuhu AT, Tromeur C, Couturaud F, Huisman MV, Klok FA. Use of clinical prediction rules and D-dimer tests in the diagnostic management of pregnant patients with suspected acute pulmonary embolism. (2017) Blood reviews. 31 (2): 31-36. doi:10.1016/j.blre.2016.09.003 - Pubmed