YEARS Algorithm Versus Wells' Score: Predictive Accuracies in Pulmonary Embolism Based on the Gold Standard CT
Ahmed Abdelaal Ahmed Mahmoud M Alkhatip1,2, Maria Donnelly3, Lindi Snyman3
1Department of Anesthesia, Beni-Suef University Hospital and Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
Insights
The YEARS algorithm demonstrates superior sensitivity and negative predictive value for diagnosing pulmonary embolism compared to Wells
Area of Science:
- Pulmonary vascular disease
- Diagnostic accuracy studies
- Clinical decision rules
Background:
- Pulmonary embolism (PE) diagnosis relies on clinical decision rules.
- Wells' score and YEARS algorithm are commonly used for PE risk stratification.
- CT pulmonary angiography (CTPA) is the gold standard for PE confirmation.
Purpose of the Study:
- To compare the predictive performance of Wells' score and the YEARS algorithm in patients undergoing CTPA for suspected PE.
- To evaluate sensitivity, specificity, and diagnostic odds ratio for both clinical decision rules.
Main Methods:
- Retrospective analytical study involving 794 patients.
- Application of Wells' score and YEARS algorithm to patient data.
- Comparison of diagnostic performance metrics against CTPA results.
Main Results:
- The YEARS algorithm showed higher sensitivity (97.44%) and negative predictive value (98%) than Wells' score (74.36% and 92.4%, respectively).
- Wells' score exhibited higher specificity (33.94%) compared to the YEARS algorithm (13.97%).
- The YEARS algorithm had a higher diagnostic odds ratio (6.27 vs. 1.48), but both scores had poor positive predictive values (10.9%).
Conclusions:
- Both Wells' score and the YEARS algorithm can effectively aid in excluding pulmonary embolism.
- The YEARS algorithm offers improved negative predictive value for PE diagnosis.
- Clinical decision rules, including YEARS and Wells', demonstrate limitations in positive predictive value.
Objectives:
This study retrospectively applied Wells' score and YEARS algorithm to the same sample of patients to evaluate the predictive performance of each when compared with the gold standard CT pulmonary angiography.
Design:
Retrospective analytical study.
Setting:
A tertiary University Hospital in Ireland.
Patients:
Data from 794 patients who underwent CT pulmonary angiography to rule out pulmonary embolism.
Interventions:
Patients were analyzed using retrospective application of both Wells' score and YEARS algorithm. Sensitivity, specificity, and diagnostic odds ratio were calculated and compared.
Measurements And Main Results:
Of 794 scans, 78 (9.8%) were positive for pulmonary embolism. The YEARS algorithm was more sensitive than the Wells' score (97.44% vs 74.36%) but was less specific (13.97% vs 33.94%). Furthermore, the diagnostic odds ratio of YEARS was higher than Wells' score (6.27 vs 1.48). YEARS provides better negative predictive value (98% vs 92.4%), and both scores have poor positive predictive value (10.9%).
Conclusions:
Both scores successfully exclude pulmonary embolism, although YEARS has a better negative predictive value. Both exhibit poor positive predictive value.
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