YEARS algorithm
Rule out pulmonary embolism with a D-dimer threshold adapted to three clinical items
- ESC 2019 PE guideline
- AWMF S2k VTE 2023
- YEARS study, 12 Dutch hospitals
Sources last checked: 2026-10-13
YEARS algorithm
Rule out pulmonary embolism with a D-dimer threshold adapted to three clinical items
Validated in haemodynamically stable patients with suspected PE; the original study excluded pregnant women (use the pregnancy-adapted Artemis version there). The YEARS items and D-dimer are assessed together — do not combine YEARS with an age-adjusted cut-off.
Interpretation
| PE excluded — no YEARS item, D-dimer < 1000 µg/L | PE is considered excluded without CTPA under the YEARS strategy. |
|---|---|
| PE excluded — ≥ 1 YEARS item, D-dimer < 500 µg/L | PE is considered excluded without CTPA under the YEARS strategy. |
| PE not excluded — CTPA in the YEARS strategy | No item with D-dimer ≥ 1000 µg/L, or ≥ 1 item with D-dimer ≥ 500 µg/L: the YEARS strategy proceeds to CT pulmonary angiography. |
What is the YEARS algorithm?
YEARS combines three items from the Wells score — clinical signs of DVT, haemoptysis, and PE as the most likely diagnosis — with a D-dimer threshold that depends on them: 1000 µg/L when no item is present, 500 µg/L when at least one is. It was tested by van der Hulle and colleagues in 3,465 patients across 12 Dutch hospitals (Lancet 2017), where it avoided CTPA in 48 % of patients versus 34 % with Wells and a fixed threshold.
When to use it
- Stable patients with suspected PE in the emergency department, ward or outpatient clinic.
- When you want to reduce CTPA use without losing safety (3-month VTE rate 0.61 % after exclusion).
- When D-dimer can be drawn at the same time as the clinical assessment.
When not to use it
- Haemodynamic instability or high clinical suspicion of massive PE.
- Pregnancy — use the pregnancy-adapted YEARS (Artemis) algorithm, which adds compression ultrasound for symptomatic legs.
- Together with an age-adjusted D-dimer threshold — the two strategies were not validated combined.
Clinical pearls and limitations
- Validated in haemodynamically stable patients with suspected PE; the original study excluded pregnant women (use the pregnancy-adapted Artemis version there). The YEARS items and D-dimer are assessed together — do not combine YEARS with an age-adjusted cut-off.
- D-dimer is measured in every patient, including those with YEARS items — unlike Wells pathways, where high probability skips D-dimer.
- Thresholds are strict: D-dimer exactly 1000 µg/L with no item, or exactly 500 µg/L with an item, does not exclude PE.
- Check whether your laboratory reports FEU or DDU; YEARS thresholds refer to FEU (ng/mL = µg/L).
- The 'PE most likely diagnosis' item remains subjective and drives most of the variation between doctors.
Frequently asked questions
What are the three YEARS criteria?
Clinical signs of deep vein thrombosis, haemoptysis, and pulmonary embolism being the most likely diagnosis.
What D-dimer cut-off does YEARS use?
Below 1000 µg/L (ng/mL FEU) with no YEARS item, or below 500 µg/L with one or more items, PE is considered excluded. In all other patients the YEARS strategy proceeds to CTPA.
Is the YEARS algorithm recommended in European guidelines?
ESC 2019 lists YEARS as an accepted way to adapt the D-dimer threshold to clinical probability, and the German AWMF S2k guideline (2023) describes it as an alternative strategy.
Can YEARS be used in pregnancy?
Only in its pregnancy-adapted form (Artemis study, NEJM 2019), which adds leg ultrasound when DVT signs are present.
Evidence and guidelines
- Primary source: van der Hulle T et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017;390(10091):289-297.
- ESC 2019 acute PE guideline, section 4 (YEARS model; D-dimer cut-off adapted to clinical probability).
- AWMF S2k 065-002 (2023), section 3.2.2 (YEARS-Algorithmus).
- van der Pol LM et al. Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism (Artemis). N Engl J Med 2019;380:1139-1149.
Have a follow-up question?
Medelix answers clinical questions from current guidelines and studies — every statement with its source.
Ask Medelix about the YEARS algorithmRelated calculators
- Wells score (pulmonary embolism)Clinical probability for PE
- Revised Geneva score (simplified)Clinical pre-test probability of pulmonary embolism, one point per item
- Age-adjusted D-dimer cut-offD-dimer threshold for excluding PE in patients over 50 (age × 10 µg/L)
- PERC rulePulmonary Embolism Rule-out Criteria — skip D-dimer when gestalt probability is already low
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