The impact of implementing a modified YEARS algorithm on the diagnosis of pulmonary embolism

Abstract

A low test threshold for pulmonary embolism(PE) and over reliance on imaging, especially CT pulmonary angiograms(CTPA) is a common behaviour pattern among physicians. Interventions to improve this low threshold for CTPA testing have been mostly ineffective. The innovative Dutch YEARS study reported fewer CTPA examinations in PE diagnosis(van der Hulle et al. Lancet 2017;390:289). However, the YEARS algorithm have not been evaluated in routine clinical practice. Thus, we examined the effects of implementing a pragmatic, modified version of the YEARS algorithm in PE diagnosis. Methods: This is a prospective study of consecutive hospitalized adult patients who underwent CTPA for PE in an acute medicine department. In 2016 we initiated an audit-feedback program to improve the adherence to evidence based guidelines for PE diagnosis and thus, increase the diagnostic rate of PE from CTPA. In 2018 we implemented a modified YEARS protocol. Results: In 2016 the PE detection rate from CTPA was 7.8%. This was associated with more frequent assessment of pre-test risks and D-dimer testing but an insignificant increase in PE diagnosis from CTPA compared with 2015(7%). In 2018, following the introduction of the modified YEARS protocol, this PE diagnosis rate increased to 25%(p Conclusions: Physician education and real-time feedback had a small effect in improving adherence to PE diagnostic protocols and reducing CTPA testing. Implementation of the YEARS protocol resulted in further improvements and merits more extensive evaluation in secular practice.