YEARS – D-Dimer Under 1000 But Over Age-Adjusted? Be Careful…

October 16, 2020

Written by Clay Smith

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YEARS was safe and would have reduced imaging in this retrospective external validation study, but it would have missed 17 PEs. All 17 patients had zero YEARS criteria and D-dimer <1000 but over their age-adjusted cutoff.

Why does this matter?
We covered YEARS back in the day. MDCalc has a brilliant online calculator. If a patient lacks PE as the most likely diagnosis, hemoptysis, or signs of DVT, they are allowed a D-dimer up to 1000. Overall, this approach has been shown to be safe. Might this external validation study have found a caveat?

Dimer <1000 but over age-adjusted cutoff may be a problem…
This study used data that was collected for three prior outpatient PE studies, 3,314 patients, and applied the YEARS criteria post-hoc. Prevalence of PE in this combined group was 22%. If YEARS had been applied, 43% of patients would have had PE excluded with no imaging. There were 17 patients with VTE (15 PEs + 2 proximal DVTs out of 1,142; 1.6%) that would have been missed; all had zero YEARS criteria and a D-dimer <1000. Interestingly, all 17 had a D-dimer above their age-adjusted cutoff. Big picture – if YEARS had been applied to this population, it would have been safe and would have reduced imaging. However, the authors offer the caveat to use caution in patients with zero YEARS criteria, D-dimer <1000 but above the patient’s age-adjusted cutoff. This YEARS modification may make it even more effective. This will need prospective validation. For now, YEARS looks good, but be careful in this subgroup.

Source
External validation of the YEARS diagnostic algorithm for suspected pulmonary embolism. J Thromb Haemost. 2020 Aug 31. doi: 10.1111/jth.15083. Online ahead of print.

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