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YEARS Algorithm for Pulmonary Embolism

YEARS rules out PE without imaging when there are no YEARS items (clinical signs of DVT, hemoptysis, PE most likely diagnosis) and D-dimer < 1000 ng/mL, or ≥1 item and D-dimer < 500 ng/mL; everyone else gets CTPA. It cut CTPA use by 14% versus Wells with a 0.61% 3-month VTE rate.

Clinical signs of deep vein thrombosis (yes/no, +1)
Hemoptysis (yes/no, +1)
PE is the most likely diagnosis (yes/no, +1)
D-dimer (FEU) (ng/mL or µg/L or mg/L)

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Interpretation

Result	Meaning
0 items + D-dimer < 1000 ng/mL	PE excluded
≥ 1 item + D-dimer < 500 ng/mL	PE excluded
Otherwise	CTPA

Formula

YEARS items: clinical signs of DVT, hemoptysis, PE most likely diagnosis. Threshold = 1000 ng/mL FEU if 0 items, 500 ng/mL if ≥1 item. D-dimer below threshold → PE excluded.

Clinical pearls

YEARS is applied with D-dimer drawn at the same time as the clinical assessment; it is not combined with age adjustment in the original study.
A pregnancy-adapted YEARS algorithm (Artemis) adds compression ultrasound for leg symptoms; this calculator is the non-pregnant version.
Patients with hemodynamic instability or high suspicion should go directly to imaging regardless of YEARS.

Examples

years algorithm no dvt signs no hemoptysis pe not most likely d-dimer 850 YEARS criteria hemoptysis, d dimer 700 years algorithm leg swelling, pe most likely, dimer 400

FAQ

What are the YEARS criteria?

Clinical signs of DVT, hemoptysis, and PE being the most likely diagnosis. With none, a D-dimer under 1000 ng/mL excludes PE; with any, the cutoff is 500 ng/mL.

Is YEARS safe?

In 3465 patients the 3-month VTE rate after PE was excluded was 0.61%, comparable to Wells-based strategies, with 14% fewer CTPAs.

Evidence

van der Hulle T et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study). Lancet 2017;390:289–97.

Cardiology · Reviewed 2026-10-14 · Methodology