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:
Criteria
- Does the patient have clinical signs or symptoms of deep vein thrombosis (DVT)?
- Does the patient have hemoptysis?
- Is PE the most likely diagnosis?
Application
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.
Interpretation
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.
Practical Points
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.