YEARS Criteria & D-Dimer Algorithm for Pulmonary Embolism
Apply standard or pregnancy-adapted YEARS to three clinical criteria and an explicitly labeled FEU D-dimer, including the pregnancy compression-ultrasound branch.
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About
The YEARS criteria calculator applies a named diagnostic-management algorithm for adults with suspected pulmonary embolism, not a weighted prognostic score. Its three clinician-assessed items are clinical signs of DVT, hemoptysis, and PE as the most likely diagnosis. Their count selects one of two FEU D-dimer thresholds. YEARS is the study/algorithm name; this page does not invent an expanded acronym. [1]
Pregnancy-adapted YEARS adds a symptomatic-leg compression-ultrasound branch. ARTEMIS enrolled currently pregnant adults age ≥18; postpartum patients need the applicable postpartum protocol. This is not screening for nonspecific symptoms and does not independently diagnose PE or DVT. [2]
Formula
Interpretation
Standard versus pregnancy-adapted YEARS
| Pathway | Population | D-dimer branch | CUS branch |
|---|---|---|---|
| Standard YEARS | Adult suspected PE, not currently pregnant | Zero items: <1000; ≥1: <500 μg/L FEU | Not part of this implementation |
| Pregnancy-adapted YEARS | Currently pregnant adult with suspected PE | Same thresholds, not trimester-specific | DVT signs require symptomatic-leg CUS; negative continues, positive proximal DVT stops, incomplete withholds completion |
A met threshold is source-pathway context, not a standalone diagnosis or an imaging order. No low/medium/high YEARS risk categories or individual probabilities are assigned.
Current 2026 guideline boundary
The 2026 AHA/ACC multisociety guideline supports standard YEARS in appropriate adults (COR 2a, LOE B-R) and pregnancy-adapted YEARS (COR 2b, LOE B-NR). It recommends imaging when clinical probability is high (>50%); this calculator does not estimate that probability. D-dimer studies generally excluded therapeutic anticoagulation. Do not use an online calculation to delay evaluation in instability, critical illness, or a pathway already indicating imaging. [3]
The guideline has a separately published correction. No YEARS threshold change is attributed to that correction here. [4]
Original YEARS and ARTEMIS evidence
In YEARS 2017, 3,465 patients were assessed and 456 (13%) had baseline PE. Among 2,946 ruled out and untreated, 18 had symptomatic VTE within three months: 0.61% (95% CI 0.36–0.96); six had fatal PE: 0.20% (0.07–0.44). CTPA was not indicated in 48%, versus 34% with hypothetical Wells plus a fixed 500 threshold, a 14-percentage-point difference. These are cohort observations, not an individual probability. [1]
ARTEMIS 2019 analyzed 498 pregnant patients: baseline PE was 20/498 (4.0%). Follow-up found one proximal DVT (0.21%) and no PE. CTPA was not indicated in 39% overall: 65%, 46%, and 32% in the first, second, and third trimesters. Different trimester efficiency does not mean different trimester thresholds. [2]
External validation and assay limitations
Eddy 2020 retrospectively applied YEARS to 3,314 patients. Of 1,423 who would have been ruled out without imaging, 17 had PE at initial testing. All 17 had zero YEARS items, D-dimer below 1000, but above their age-adjusted cutoff. In that specific subgroup, 17/272 had PE: 6.3% (95% CI 3.9–9.8). This cautions against treating pathways as interchangeable; it does not alter the original algorithm implemented here. Clinical context, prevalence, and the selected validated pathway matter. [5]
Hamer 2021 compared four D-dimer assays and found assay-dependent distributions affecting imaging rates. FEU labeling is necessary, not proof that assays are interchangeable. This tool neither guesses an assay nor converts DDU or applies assay-specific correction factors. [6]
YEARS vs Wells, PERC, and PESI
Wells PE expresses suspected-PE pretest probability. PERC is a conditional rule-out framework after sufficiently low probability is independently established. YEARS combines three items with D-dimer. PESI/sPESI assess severity after confirmed PE. There is no score conversion or import of another calculator result. Age-adjusted D-dimer is a separate strategy: this original YEARS model does not use age ×10 or a hybrid threshold. [1, 3]
References
- van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet. 2017;390(10091):289–297. PMID 28549662. DOI 10.1016/S0140-6736(17)30885-1.
- van der Pol LM, Tromeur C, Bistervels IM, et al. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med. 2019;380:1139–1149. PMID 30893534. DOI 10.1056/NEJMoa1813865.
- Creager MA, Barnes GD, Giri J, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. Circulation. 2026;153:e977–e1051. PMID 41712677. DOI 10.1161/CIR.0000000000001415.
- Creager MA, Barnes GD, Giri J, et al. Correction to the 2026 Acute Pulmonary Embolism Guideline. Circulation. 2026;154(2):e24. PMID 42441758. DOI 10.1161/CIR.0000000000001462.
- Eddy M, Robert-Ebadi H, Richardson L, et al. External validation of the YEARS diagnostic algorithm for suspected pulmonary embolism. J Thromb Haemost. 2020;18(12):3289–3295. PMID 32869501. DOI 10.1111/jth.15083.
- Hamer HM, Stroobants AK, Bavalia R, et al. Diagnostic accuracy of four different D-dimer assays: A post-hoc analysis of the YEARS study. Thromb Res. 2021;201:18–22. PMID 33626463. DOI 10.1016/j.thromres.2021.02.003.
FAQ
Clinical signs of DVT, hemoptysis, and PE as the most likely diagnosis. Each requires an explicit clinical Yes or No. The count is 0–3, but the algorithm uses only zero versus one or more; there are no weighted low/medium/high YEARS categories.
Sources: [1]
YEARS is the study and algorithm name, not a prognostic score or an acronym expanded here. It combines three clinical items with a D-dimer threshold in a diagnostic-management pathway.
Sources: [1]
Supported units are ng/mL FEU, μg/L FEU, and mg/L FEU. 1 ng/mL FEU equals 1 μg/L FEU; 1 mg/L FEU equals 1000 μg/L FEU. DDU or unknown reporting basis gives no threshold result. The calculator never guesses a DDU-to-FEU conversion or an assay; numerical assay results are not universally interchangeable.
Wells PE expresses pretest probability in suspected PE. PERC requires independently established sufficiently low probability. YEARS combines three items with D-dimer. PESI/sPESI assess severity after PE is confirmed. None is converted into another model here.
Sources: [3]
ARTEMIS adapted YEARS for currently pregnant adults with suspected PE by adding symptomatic-leg compression ultrasonography when DVT signs are present. It keeps the same zero-item <1000 and ≥1-item <500 μg/L FEU thresholds in every trimester. Trimester differences in imaging avoidance do not create trimester thresholds.
Sources: [2]
The source pathway requires compression ultrasonography of the symptomatic leg. Negative CUS continues to the <500 D-dimer branch without removing the DVT-sign item. Confirmed proximal DVT stops the D-dimer branch; ARTEMIS did not proceed to CTPA for that workup. Incomplete or nondiagnostic CUS gives no completed result. This is source context, not a calculator diagnosis, imaging cancellation, or anticoagulation order.
Sources: [2]
This implementation covers currently pregnant adults, consistent with ARTEMIS enrollment age ≥18. It is not automatically applied postpartum or in children. The applicable postpartum diagnostic protocol remains separate.
Sources: [2]
YEARS assessed 3,465 patients; among 2,946 ruled out and untreated, three-month symptomatic VTE occurred in 18 (0.61%). ARTEMIS analyzed 498 pregnant patients, with one proximal DVT and no PE during follow-up; CTPA was not indicated in 39%. These are historical cohort findings, not an individual probability.
In a retrospective external validation, 17 of 272 patients with zero YEARS items, D-dimer below 1000 but above their age-adjusted cutoff had PE at initial testing (6.3%). This source-specific finding highlights pathway and population differences; it does not silently change original YEARS into an age-adjusted algorithm.
Sources: [5]
The 2026 guideline recommends imaging for high clinical probability (>50%), which this calculator does not estimate. D-dimer studies generally excluded therapeutic anticoagulation. An applicable validated protocol must establish eligibility; unstable or critically ill patients and patients whose pathway already indicates imaging must not wait for an online rule.
Sources: [3]
Related Calculators
Wells PE
Calculate the seven-criterion Wells score for pulmonary embolism with modified two-level and standard three-level classifications.
PERC Rule
Check all eight PERC criteria for a low-probability adult suspected-PE assessment, with exact age, pulse, room-air oxygen, history, and examination boundaries.
PESI / sPESI
Calculate original PESI and independently validated simplified PESI after confirmed acute pulmonary embolism from direct vital signs and source-defined clinical factors.
Disclaimer
Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.