Lower prevalence of subsegmental pulmonary embolism after application of the YEARS diagnostic algorithm.

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 0372544 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2141 (Electronic) Linking ISSN: 00071048 NLM ISO Abbreviation: Br J Haematol Subsets: MEDLINE
    • Publication Information:
      Publication: Oxford : Wiley-Blackwell
      Original Publication: Oxford : Blackwell Scientific Publications
    • Subject Terms:
      Algorithms* ; Pulmonary Embolism*/diagnostic imaging ; Pulmonary Embolism*/mortality ; Tomography, X-Ray Computed*; Adult ; Aged ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Survival Rate
    • Abstract:
      The rate of identified isolated subsegmental pulmonary embolism (ssPE) has doubled with advances in computed tomography pulmonary angiography (CTPA) technology, but its clinical relevance is debated. The YEARS diagnostic algorithm was shown to safely reduce the number of required CTPAs in the diagnostic management of PE. We hypothesized that the higher threshold for performing CTPA in YEARS was associated with a lower prevalence of ssPE compared to the conventional diagnostic algorithm. We compared 2291 consecutive patients with suspected PE managed according to YEARS to 3306 consecutive control patients managed according to the Wells score for the prevalence of isolated ssPE. In the YEARS cohort, 52% were managed without CTPA, 12% had pulmonary embolism (PE) of which 10% were isolated ssPE, and the 3-month diagnostic failure rate was 0·35%. In the control cohort, 32% were managed without CTPA, 20% had PE of which 16% were isolated ssPE, and the 3-month failure rate was 0·73%. The isolated ssPE prevalence was significantly lower in YEARS (absolute difference 6·2% (95% confidence interval [CI] 1·4-10), Odds Ratio 0·58 (95% CI 0·37-0·90). In conclusion, YEARS is associated with a lower prevalence of isolated ssPE, due to reduction in CTPAs by the higher D-dimer threshold. This was however not associated with a higher risk of recurrent VTE during follow-up.
      (© 2018 The Authors. British Journal of Haematology published by John Wiley & Sons Ltd and British Society for Haematology.)
    • References:
      Br J Haematol. 2008 Jan;140(2):218-22. (PMID: 18028485)
      AJR Am J Roentgenol. 2015 Aug;205(2):271-7. (PMID: 26204274)
      Lancet. 2017 Jul 15;390(10091):289-297. (PMID: 28549662)
      JAMA. 2006 Jan 11;295(2):172-9. (PMID: 16403929)
      Eur Heart J. 2014 Dec 1;35(45):3145-6. (PMID: 25452462)
      Chest. 2016 Feb;149(2):315-352. (PMID: 26867832)
      J Thromb Haemost. 2006 Apr;4(4):724-31. (PMID: 16634736)
      QJM. 2010 Feb;103(2):91-7. (PMID: 20040533)
      Eur Respir J. 2017 Jun 29;49(6):. (PMID: 28663318)
      Thromb Res. 2010 Oct;126(4):e266-70. (PMID: 20709366)
      Blood. 2013 Aug 15;122(7):1144-9; quiz 1329. (PMID: 23736701)
      J Am Coll Cardiol. 2016 Mar 1;67(8):976-90. (PMID: 26916489)
      Acta Radiol. 2007 Mar;48(2):165-70. (PMID: 17354136)
      Eur Heart J. 2014 Nov 14;35(43):3033-69, 3069a-3069k. (PMID: 25173341)
      Ann Am Thorac Soc. 2015 Jul;12(7):1022-9. (PMID: 25961445)
      Psychol Bull. 1968 Oct;70(4):213-20. (PMID: 19673146)
      J Thromb Haemost. 2010 Aug;8(8):1716-22. (PMID: 20546118)
      Am J Respir Crit Care Med. 2002 Feb 1;165(3):345-8. (PMID: 11818319)
    • Contributed Indexing:
      Keywords: D-dimer; computed tomography; diagnosis; pulmonary embolism; subsegmental pulmonary embolism
    • Publication Date:
      Date Created: 20180911 Date Completed: 20190715 Latest Revision: 20190715
    • Publication Date:
      20231215
    • Accession Number:
      PMC6282699
    • Accession Number:
      10.1111/bjh.15556
    • Accession Number:
      30198551