Evidence map›Paper›PMID 36371248›Full record

ArticleAnnals of emergency medicine2023

Comparison of YEARS and Adjust-Unlikely D-dimer Testing for Pulmonary Embolism in the Emergency Department.

Kerstin de Wit, Fayad Al-Haimus, Yang Hu, Rick Ikesaka, Noel Chan, Quazi Ibrahim, Joshua Klyn, Natasha Clayton, Federico Germini

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In one paragraph

Article in Annals of emergency medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Observational
  6. Article
  7. Article
  8. Review
  9. Contemporary approaches to pulmonary embolism diagnosis: a clinical review.Clinical and experimental emergency medicine · 2024
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Kerstin de WitDepartment of Emergency Medicine and Medicine, Queens University, Kingston, and Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. Electronic address: kerstin.deWit@queensu.ca.
Fayad Al-HaimusDivision of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Yang HuDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Rick IkesakaDivision of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Noel ChanDivision of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Quazi IbrahimDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Joshua KlynDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Natasha ClaytonDepartment of Medicine, McMaster University, Hamilton, ON, Canada; Emergency Department, Hamilton Health Sciences, Hamilton, ON, Canada.
Federico GerminiDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

STUDY

objectiveWe prospectively assessed the diagnostic accuracy of YEARS and a modified age-adjusted clinical decision rule ("Adjust-Unlikely") for pulmonary embolism (PE) testing in the emergency department.

methodsThis study was conducted in tertiary care Canadian emergency departments. When the D-dimer was <500 ng/ml, PE was excluded. Pulmonary imaging for PE was performed when the D-dimer was ≥500 ng/ml. Patients were followed for 30 days, and PE outcomes were independently adjudicated. Physicians systematically recorded the presence or absence of YEARS items (PE most likely, hemoptysis, signs of deep venous thrombosis) prior to D-dimer testing and imaging. We analyzed the diagnostic accuracy of YEARS and the "Adjust-Unlikely" rule. Age adjustment (age x 10 in those >50 years old) was applied in patients where PE was not the most likely diagnosis and 500 ng/ml threshold when PE was most likely.

resultsOne thousand seven hundred three patients were included, median age 62 (50, 74), 58% female, PE prevalence 8.0%. YEARS sensitivity for PE diagnosis was 92.6% (87.0, 96.0%) and specificity 45.0% (42.5, 47.5%). Adjust-Unlikely sensitivity was 100.0% (97.2, 100.0%) and specificity 32.4% (30.1, 34.8%). Posttest probability of PE in the group of patients with PE excluded by D-dimer between 500 ng/ml and the adjusted limit was 2.8% (1.6, 5.1%) for YEARS and 0.0% (0.0, 2.6%) for the "Adjust-Unlikely" rule.

conclusionThe "Adjust-Unlikely" rule would modestly reduce imaging and identify all cases of PE. YEARS would substantially reduce imaging but miss 1 in 14 cases of PE.

Indexed as

Pulmonary EmbolismCanadaEmergency Service, HospitalFemaleFibrin Fibrinogen Degradation ProductsHumansMaleMiddle AgedFibrin Fibrinogen Degradation Productsfibrin fragment D

Identifiers

PMID36371248

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.