Simplified diagnostic management of suspected pulmonary embolism
YEARS trial design and results
Design
Prospective, multicentre cohort management study
Treatment
YEARS algorithm: three clinical items with a D-dimer threshold of 1000 ng/mL if none are present, 500 ng/mL if any are
Control
Conventional diagnostic pathway
Population
3465 consecutive patients with clinically suspected pulmonary embolism, 456 (13%) diagnosed at baseline
Follow-up
3 months
Primary endpoint
Venous thromboembolism during 3-month follow-up after PE was excluded
Result
Pulmonary embolism was safely excluded in the 2946 patients (85%) managed without a diagnosis at baseline, and CT pulmonary angiography was avoided in an absolute 14% more patients than the standard algorithm, consistently across ages and subgroups.
Secondary endpoints
Proportion of CT pulmonary angiograms avoided
In our study pulmonary embolism was safely excluded by the YEARS diagnostic algorithm in patients with suspected pulmonary embolism. The main advantage of the YEARS algorithm in our patients is the absolute 14% decrease of CTPA examinations in all ages and across several relevant subgroups.
The trial authors, in the published abstract
How it has aged
The most widely adopted of the probability-adjusted strategies, and the one with a pregnancy-specific extension (Artemis). Note it is a management cohort, not a randomised comparison — the safety claim rests on a low observed failure rate rather than on a control arm.
Publications
Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study
van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017 Jul 15;390(10091):289-297.
PE safely excluded in 85% of patients without a baseline diagnosis
Absolute 14% reduction in CT pulmonary angiography
Single-arm management design rather than a randomised comparison