Eddy Maggie, Robert-Ebadi Helia, Richardson Lydia, Bellesini Marta, Verschuren Frank, Moumneh Thomas, Meyer Guy, Righini Marc, Le Gal Grégoire
Internal Medicine, Comox, BC, Canada.
Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
J Thromb Haemost. 2020 Dec;18(12):3289-3295. doi: 10.1111/jth.15083. Epub 2020 Oct 23.
Validated diagnostic algorithms are used to manage patients with suspected pulmonary embolism (PE). The recently published YEARS study proposed a simplified diagnostic strategy to reduce the use of computed tomography pulmonary angiography.
To externally validate this strategy in an independent cohort.
We analyzed data from three previous prospective cohort studies of outpatients with suspected PE. We retrospectively applied the YEARS algorithm. The three YEARS clinical criteria are: clinical signs of deep vein thrombosis, hemoptysis, and PE as the most likely diagnosis. If zero YEARS criteria are met, a D-dimer < 1000 ng/mL will rule out PE. If ≥1 YEARS criteria are met, a D-dimer < 500 ng/mL will rule out PE.
Of the 3314 patients, 731 (22.1%) had PE. Applying the YEARS diagnostic algorithm, 1423 (42.9%) patients could have had PE ruled out without imaging. Of these patients, 17 (1.2%; 95% confidence interval 0.8-1.9) were diagnosed with PE at initial testing. All 17 had no YEARS item and a D-dimer < 1000 ng/mL. All 17 had a D-dimer level above their age-adjusted cutoff. Among the 272 patients with no YEARS criteria and a D-dimer < 1000 ng/mL but above their age-adjusted D-dimer cutoff, PE was diagnosed in 6.3% (17/272; 95% confidence interval 3.9-9.8).
We provide external validation of the YEARS diagnostic algorithm in an independent cohort. The rule appears to safely exclude PE. However, caution is required in patients with no YEARS item and a D-dimer < 1000 ng/mL but above their age-adjusted D-dimer cutoff.
经过验证的诊断算法用于管理疑似肺栓塞（PE）的患者。最近发表的YEARS研究提出了一种简化的诊断策略，以减少计算机断层扫描肺动脉造影的使用。
在一个独立队列中对该策略进行外部验证。
我们分析了之前三项针对疑似PE门诊患者的前瞻性队列研究的数据。我们回顾性应用了YEARS算法。YEARS的三项临床标准为：深静脉血栓形成的临床体征、咯血以及PE为最可能的诊断。如果未满足任何一项YEARS标准，D-二聚体<1000 ng/mL可排除PE。如果满足≥1项YEARS标准，D-二聚体<500 ng/mL可排除PE。
在3314例患者中，731例（22.1%）患有PE。应用YEARS诊断算法，1423例（42.9%）患者无需影像学检查即可排除PE。在这些患者中，17例（1.2%；95%置信区间0.8 - 1.9）在初始检测时被诊断为PE。所有17例均无YEARS项目且D-二聚体<1000 ng/mL。所有17例的D-二聚体水平均高于其年龄校正临界值。在272例无YEARS标准且D-二聚体<1000 ng/mL但高于其年龄校正D-二聚体临界值的患者中，6.3%（17/272；95%置信区间3.9 - 9.8）被诊断为PE。
我们在一个独立队列中对YEARS诊断算法进行了外部验证。该规则似乎可以安全地排除PE。然而，对于无YEARS项目且D-二聚体<1000 ng/mL但高于其年龄校正D-二聚体临界值的患者，需要谨慎对待。
