Cancer Can't Stop YEARS
Keep cutting down those CTPAs with "Hydra".
We’re all very happy with the YEARS algorithm – and, frankly, anything that treats patients with suspected pulmonary embolism on a continuum of risk, rather than a homogenous mob.
A critique of YEARS has been whether it could be safely applied in patients with active cancer.
For those of you counting at home, that’s 47 PEs diagnosed on the initial visit for the YEARS team and 57 PEs in the “CTPA everyone” team. In the 90-day follow-up window:
“In the YEARS group, 5 patients (1.8%) were diagnosed with VTE during the 3-month follow-up: 3 patients had a nonfatal PE and 2 patients had a possible PE-related death. In the CTPA-only group, 15 patients (5.5%) were diagnosed with VTE during the 3-month follow-up: 5 patients had a nonfatal PE, 2 patients had a fatal PE, 5 patients had a possible PE-related death, and 3 patients had a DVT.”
Clearly, the YEARS criteria does not have protective powers, but the result is reassuring nonetheless – and 22% fewer CTs performed to boot.
The study actually planned to enroll 1,566 patients to attain their initial statistical power for non-inferiority, but was able to stop early due to the preponderance of excess VTE in the CTPA-only group.
Go forth and risk-stratify!