YEARS Algorithm Versus Wells’ Score: Predictive Accuracies in Pulmonary Embolism Based on the Gold Standard CT Pulmonary Angiography*

Abstract

Objectives: This study retrospectively applied Wells’ score and YEARS algorithm to the same sample of patients to evaluate the predictive performance of each when compared with the gold standard CT pulmonary angiography. Design: Retrospective analytical study. Setting: A tertiary University Hospital in Ireland. Patients: Data from 794 patients who underwent CT pulmonary angiography to rule out pulmonary embolism. Interventions: Patients were analyzed using retrospective application of both Wells’ score and YEARS algorithm. Sensitivity, specificity, and diagnostic odds ratio were calculated and compared. Measurements and Main Results: Of 794 scans, 78 (9.8%) were positive for pulmonary embolism. The YEARS algorithm was more sensitive than the Wells’ score (97.44% vs 74.36%) but was less specific (13.97% vs 33.94%). Furthermore, the diagnostic odds ratio of YEARS was higher than Wells’ score (6.27 vs 1.48). YEARS provides better negative predictive value (98% vs 92.4%), and both scores have poor positive predictive value (10.9%). Conclusions: Both scores successfully exclude pulmonary embolism, although YEARS has a better negative predictive value. Both exhibit poor positive predictive value.

Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism

“…A conventional algorithm uses a bayesian approach with an initial subjective estimate of pretest probability, D-dimer testing (in patients with non–high clinical probability) and if the D-dimer level is above a certain threshold, chest imaging (computed tomography pulmonary angiography (CTPA), or pulmonary ventilation/perfusion [V̇/Q̇] scanning). Because clinical signs of PE and D-dimer testing have low specificity, CTPA is frequently used, with a reported diagnostic yield of only about 10% . CTPA use has increased over the past 2 decades, resulting in added costs and patient radiation exposure …”

“…Because clinical signs of PE and D-dimer testing have low specificity, CTPA is frequently used, with a reported diagnostic yield of only about 10%. [1][2][3] CTPA use has increased over the past 2 decades, resulting in added costs and patient radiation exposure. 4,5 Various strategies have been derived to safely reduce the use of CTPA.…”

Diagnostic Test Accuracy of the YEARS Algorithm for Pulmonary Embolism

“…In question 3, one study 29 implemented inappropriate exclusions by omitting all participants under 50-years-old. In question 4, three studies 9,30,31 interpreted the index test without knowledge of the reference test. One study 9 did not blind clinicians to the D-dimer result before participants had YEARS applied to them.…”

“…In total, 13,993 participants were included across 10 studies 9,[29][30][31][32][33][34][35][36][37] with no one study making up more than 25% of the total review cohort. Participants were recruited internationally across 11 countries by way of 39 different hospitals.…”

A machine learning model for diagnosing acute pulmonary embolism and comparison with Wells score, revised Geneva score, and Years algorithm

“…[5] Meanwhile, other scholars reiterate that the current clinical assessment may not be used to detect APE among critically ill patients. [6,7] What's more, implementing the assessment protocol is a labor-intensive and time-consuming task, making it inapplicable to the routine diagnosis of APE. [8] Therefore, there is a need for a simple and objective assessment protocol for diagnosing APE.…”