Pregnancy-Adapted YEARS Algorithm: A Retrospective Analysis
Authors: Alden Mileto, Gina Rossi, Benjamin Krouse, Robert Rinaldi, Julia Ma, Keith Willner, David Lisbon
Published in: Western Journal of Emergency Medicine, 2024 January
Conclusion:
- Implementing the pregnancy-adapted YEARS algorithm could have decreased the use of CTPA in evaluating PE in pregnant patients.
- The algorithm's performance was comparable to prospective studies in Europe.
- Its clinical rationale aligns closely with current practices, suggesting potential for widespread adoption in clinical settings.
Objective:
- Assess the potential to reduce CTPA use in pregnant patients using the pregnancy-adapted YEARS algorithm.
- Provide external validation of the algorithm's use in the United States.
Methods:
- A retrospective chart analysis in a single healthcare system.
- Inclusion criteria: Pregnant patients over 18 years old presenting with symptoms like shortness of breath, chest pain, tachycardia, hemoptysis, deep vein thromboembolism (DVT), and elevated D-dimer (January 1, 2019 - May 31, 2022).
- The cohort was analyzed using the pregnancy-adapted YEARS algorithm, focusing on clinical signs of DVT, hemoptysis, and PE as the most likely diagnosis with a D-dimer assay.
- Patients were categorized as either aligned or not aligned with the YEARS algorithm.
- Those who did not receive initial CTPA were followed up for PE or DVT diagnosis within 30 days.
Results:
- 74 pregnant patients were included, with a PE prevalence of 2.7% (two patients).
- According to the algorithm, 36 patients did not require imaging; however, seven CTPA were performed.
- None of the patients who did not receive initial CTPA were diagnosed with PE or DVT within 30 days.
- 85.1% of patients were treated in line with the pregnancy-adapted YEARS algorithm.