Episode 11 - Pulmonary Embolism: Part 3 - YEARS Algorithm
Play • 45 min

Pulmonary Embolism.

Dr Bristi Roy (respiratory physician), Dr Vanessa Wong (respiratory advanced trainee), Dr Arwen Morath (emergency physician), Dr Pramod Chandru, Kit Rowe, and Caroline Tyers.  


van der Pol, L., Tromeur, C., Bistervels, I., Ni Ainle, F., van Bemmel, T., & Bertoletti, L. et al. (2019). Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. New England Journal Of Medicine, 380(12), 1139-1149. https://doi.org/10.1056/nejmoa1813865.

Dr Vanessa Wong (respiratory advanced trainee at Westmead Hospital).


  • PE is a leading cause of maternal death in pregnant women. 
  • However, the radiation exposure to both mother and foetus involved in the diagnosis of PE remains a complex issue. 
  • This is a multi-centre prospective study that utilised the YEARS algorithm (published several years prior) and a D-dimer to predict PE in pregnant women presenting with suspected PE. 
  • The study was conducted over a 5-year period from October 2013 to May 2019. 
  • It looked at pregnant women over the age of 18 years that had been referred to ED or the obstetric ward with concerns for potential PE.  
  • The YEARS algorithm focuses on the 3 elements of the Well’s criteria considered to be the highest yield (being clinical signs of DVT, haemoptysis, and PE as the most likely diagnosis).  
  • As part of the algorithm, those patients with clinical signs of DVT underwent a doppler US and were commenced on anticoagulation (and presumed to have a PE) if this was positive for DVT.  
  • PE was excluded in those patients without any of the YEARS criteria and with a D-dimer less than 1.0.  
  • PE was also excluded in those who had 1-3 of the YEARS criteria and a D-dimer < 0.5, while those with 1-3 of the YEARS criteria and a D-dimer > 0.5 went on to have a CTPA to look for PE. 
  • The primary outcome was the cumulative incidence of symptomatic VTE on objective testing during a 3 month follow-up period.  
  • The secondary outcome was the proportion of patients in whom CTPA was not indicated to safely exclude PE.  
  • There were 510 pregnant women recruited into the study (46% of whom were in the third trimester of pregnancy) with 12 being excluded  
  • Of the 498 patients included, 4 had signs and symptoms of DVT with a positive doppler ultrasound. 
  • 20 patients of the remaining 494 were diagnosed with PE as part of the pathway. 
  • During follow-up, one popliteal DVT was diagnosed, and no patient had PE. 
  • CTPA was avoided in 195 patients (39%). 

 Take-Home Points:

  • This provides a framework for assessing patients, particularly in the first and second trimesters of pregnancy (and may aid in safely excluding PE without CTPA for low-risk patients). 
  • However, in high-risk patients, pursuing a scan remains the most appropriate approach.  


  • 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;390:289-297. 

This episode was produced by the Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. 

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See you next time,
Caroline, Kit, Pramod, Samoda, and Shreyas.


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