Pulmonary embolism · Ruling out pulmonary embolism
Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism
| Design | Prospective multicentre management study |
|---|---|
| Treatment | Pregnancy-adapted YEARS algorithm with compression ultrasonography |
| Control | None — single-arm management study |
| Population | 498 pregnant women with suspected pulmonary embolism across all trimesters |
| Follow-up | 3 months |
| Primary endpoint | Venous thromboembolism during follow-up after PE was ruled out |
| Result | Pulmonary embolism was diagnosed in 20 (4.0%) at baseline. During follow-up one patient (0.21%, 95% CI 0.04 to 1.2) developed popliteal deep-vein thrombosis and none had pulmonary embolism. CT pulmonary angiography was avoided in 32% to 65% of patients depending on trimester. |
| Secondary endpoints | Proportion of CT pulmonary angiograms avoided by trimester |
Pulmonary embolism was safely ruled out by the pregnancy-adapted YEARS diagnostic algorithm across all trimesters of pregnancy. CT pulmonary angiography avoided in 32 to 65% of patients.
The trial authors, in the published abstract
Fills the gap every other diagnostic algorithm left, in the population where avoiding radiation matters most and where clinicians were most inclined to scan anyway. As with YEARS itself, the evidence is a management cohort rather than a randomised trial.
van der Pol LM, Tromeur C, Bistervels IM, et al. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med 2019 Mar 21;380(12):1139-1149.