Effectiveness of the YEARS algorithm added to classical clinical decision-making rules in suspected pulmonary embolism

INTRODUCTION: Pulmonary embolism (PE) is usually non-specific in terms of symptoms and signs and needs to be confirmed by an objective test. Pulmonary computed tomography angiography (PCTA) has been widely used in the diagnosis in recent years. Our aim was to evaluate the potential of the YEARS algorithm to reduce the need for PCTA compared to the classical algorithm.
METHODS: The study is a prospective observational study. Between 15.03.2018 and 15.09.2019, patients admitted to the emergency department with suspected PE and underwent PCTA according to the classical algorithm (Wells) were included in the study. YEARS criteria were reviewed according to the patients' files and general laboratory results without knowing the results of PCTA. The need for PCTA was investigated according to classical clinical decision-making rules and YEARS algorithms.
RESULTS: The study included 300 patients. According to YEARS, 69% of patients were in the group requiring PCTA, while 31% were in the YEARS pulmonary embolism exclusion group. According to YEARS, PE was detected in 16.4% of patients with an indication for PCTA, whereas only 2.2% of patients in the PCTA exclusion group had PE. In the patient cohort that included the "probable PE" group according to the Wells, the sensitivity according to the YEARS was 94.4%.
DISCUSSION AND CONCLUSION: In this study, the YEARS protocol used in addition to the classical algorithm was found to result in a 31% reduction in the need for PCTA. However, we also showed that the YEARS algorithm may be insufficient for the diagnosis of low rate, positive pulmonary embolism cases.