Abstract
Background: There is considerable emphasis on simplifying clinical prediction rules to reduce inappropriate CT pulmonary angiogram (CTPA). YEARS algorithm (YA) incorporates differential d-dimer values that serves to streamline diagnostic work-up of pulmonary embolism (PE).
Aim: To compare performance of YA with 2-tier original Well’s score (OWS) and simplified Well’s score (SWS).
Methods: Retrospective analysis of consecutive patients undergoing CTPA within 48 hours of admission at our institution from 01/07/18 – 30/09/18. Patients aged <50 years were excluded. YA and SWS were calculated from electronic patient records and compared with OWS measured at time of admission.
Results: 353 CTPAs were performed of which 102 were positive (28.9%).
1/16 patients (6.2%) had PE with YA score 0 and d-dimer >1000, 18/121 (14.9%) had PE with unlikely SWS and 34/166 (20.4%) had PE with unlikely OWS.
79/180 patients (43.8%) had PE with YA score ≥1 and d-dimer >500, 84/232 (36.2%) had PE with likely SWS and 68/187 (36.3%) had PE with likely OWS.
There was no significant difference in diagnostic capability of YA score 0 with d-dimer >1000 compared to unlikely SWS (p=0.47) and unlikely OWS (p=0.20) in ruling out PE and between YA score ≥1 with d-dimer >500 compared to likely SWS (p=0.12) and likely OWS (p=0.17) in diagnosing PE.
YA would have avoided 83 CTPAs suggested by SWS or OWS at the expense of missing 7 PE with negative YA.
Conclusion: YA has similar diagnostic capability for PE, compared to SWS and OWS. It can avoid significant number of unwarranted CTPAs but can also potentially miss a small number of PE. Further studies are needed to validate YA before it’s universal application.
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA3640.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019