Varying the D-Dimer Cutoff Based on Pretest Probability of Pulmonary Embolism

A U.S. study shows use of the YEARS criteria with a higher D-dimer cutoff reduces imaging with only a minimal increase in missed PE.

The YEARS criteria were originally tested in the Netherlands and shown to reduce imaging without an increase in missed pulmonary embolism (PE; NEJM JW Emerg Med Jul 2017 and Lancet 2017; 390:289). To determine whether the YEARS strategy is valid in the U.S., researchers performed a prospective observational study at 15 U.S. emergency departments.

Consecutive adults with clinical suspicion for PE were eligible if their Wells scores were low- or intermediate-risk and PE was not ruled out by the PERC criteria. Among 1789 patients, PE was diagnosed in 77 (4%) at the index visit and in 7 (0.4%) during follow-up.

The YEARS criteria include signs or symptoms of deep vein thrombosis, hemoptysis, and alternative diagnoses less likely than PE. Patients…

Reviewing Author

Richard L. Byyny, MD, MSc, FACEP

Disclosures

EquityZimmer; Aetna

Editorial BoardsAmerican College of Emergency Physicians Clinical Policies Committee

Richard L. Byyny, MD, MSc, FACEP

Disclosures

EquityZimmer; Aetna

Editorial BoardsAmerican College of Emergency Physicians Clinical Policies Committee

Varying the D-Dimer Cutoff Based on Pretest Probability of Pulmonary Embolism

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Reviewing Author