Abstract Number: PB2285
Meeting: ISTH 2020 Congress
Background: Validated diagnostic algorithms are used to manage patients with clinically suspected pulmonary embolism (PE). The recently published YEARS study proposed a simplified diagnostic strategy which appears to safely reduce the use of computed tomography pulmonary angiography.
Aims: To externally validate this diagnostic strategy in an independent cohort.
Methods: We analyzed data from three prospective cohort studies of outpatients with suspected PE collected between 2000 and 2006. We retrospectively applied the YEARS diagnostic algorithm to this prospectively collected data. The three YEARS clinical criteria are: clinical signs of deep vein thrombosis (DVT), hemoptysis, and PE as the most likely diagnosis. If zero YEARS criteria are met, a D-dimer < 1000 ng/mL will rule out a PE. If one or more YEARS criteria are met, a D-dimer < 500 ng/mL will rule out a PE.
Results: Of the 3314 analyzed patients, 731 (22.1%) had PE. Applying the YEARS diagnostic algorithm, 1423 (42.9%) patients could have had PE ruled out without the need for imaging. Of these patients, 17 (1.2%; 95% CI 0.8 – 1.9) were diagnosed with a PE at initial testing. All 17 had no YEARS item and a D-dimer < 1000 ng/mL. Of note, all 17 had a D-dimer level above their age-adjusted cutoff. Among the 272 patients with no YEARS criteria and a D-dimer < 1000 ng/mL but above their age-adjusted D-dimer cutoff, PE was diagnosed in 6.3% (17/272; CI 3.9 - 9.8%).
Conclusions: We provide external validation of the YEARS diagnostic algorithm in an independent cohort. Overall, the rule appears to safely exclude PE. However, caution might be required in patients with no YEARS item and a D-dimer < 1000 ng/mL but above their age-adjusted D-dimer cutoff, especially in centres with a higher prevalence of PE.
To cite this abstract in AMA style:Eddy M, Richardson L, Moumneh T, Meyer G, Righini M, Le Gal G, Robert-Ebadi H. A Simplified Management Strategy for Suspected Pulmonary Embolism: External Validation of the YEARS Diagnostic Algorithm [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/a-simplified-management-strategy-for-suspected-pulmonary-embolism-external-validation-of-the-years-diagnostic-algorithm/. Accessed January 26, 2022.
« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/a-simplified-management-strategy-for-suspected-pulmonary-embolism-external-validation-of-the-years-diagnostic-algorithm/