Pulmonary embolism presents with nonspecific clinical features, leading to excessive use of computed tomography pulmonary angiography. Although the YEARS rule—incorporating assessment of symptomatic deep vein thrombosis, hemoptysis, and whether pulmonary embolism was the most likely diagnosis—has been shown to help to reduce computed tomography pulmonary angiography exposure during pregnancy, its safety and effectiveness in the postpartum period remain to be elucidated.

To evaluate the safety and effectiveness of a postpartum-adapted YEARS algorithm incorporating elevated D-dimer thresholds, respiratory rate, and venous thromboembolism score for managing postpartum women with suspected pulmonary embolism.

A retrospective cohort was conducted among postpartum mothers with suspected pulmonary embolism from 2022 to 2023 at 2 hospitals in Xinjiang, China. Patients were assessed using the postpartum-adapted YEARS algorithm. This incorporated clinical signs of deep vein thrombosis, hemoptysis, whether pulmonary embolism was the most likely diagnosis, respiratory rate, D-dimer level, and venous thromboembolism score. Pulmonary embolism was ruled out and computed tomography pulmonary angiography was not indicated under any of the following conditions: (1) at least one YEARS criterion was present but neither a high respiratory rate (≥22 bpm) nor a D-dimer ≥5 mg/L was observed; (2) no YEARS criteria were present and the venous thromboembolism score was ≥3, without a high respiratory rate or elevated D-dimer; or (3) no YEARS criteria were present and the venous thromboembolism score was <3 regardless of additional items. Patients not meeting these criteria were indicated for computed tomography pulmonary angiography. The primary outcome was the incidence of pulmonary embolism among patients indicated and not indicated for computed tomography pulmonary angiography. The secondary outcome was the proportion of patients requiring computed tomography pulmonary angiography.

We looked at recruitment cohorts by year in case 2022 data were influenced by COVID-19 infection, which has been associated with an increased risk of pulmonary embolism. In 2023, of a total 205 women, there were 18 cases of pulmonary embolism (21.95%, 18/82) in computed tomography pulmonary angiography–indicated patients, whereas computed tomography pulmonary angiography was avoided in 60.0% (123/205) of all patients. In 2022, among 57 women, 8 pulmonary embolism cases (29.63%, 8/27) were diagnosed in the computed tomography pulmonary angiography–indicated group, and computed tomography pulmonary angiography avoidance was achieved in 52.63% (30/57). No pulmonary embolism cases were detected during follow-up. Across the overall cohort, the adapted algorithm showed a sensitivity of 100% (95% confidence interval: 87%–100%), a specificity of 65% (95% confidence interval: 58%–71%), and a negative predictive value of 100% (95% confidence interval: 98%–100%). In contrast, the routine YEARS algorithm showed a specificity of only 9% (95% confidence interval: 6%–13%) and 91.98% (241/262) of patients were indicated for computed tomography pulmonary angiography.

Our postpartum-adapted YEARS algorithm ruled out pulmonary embolism and avoided computed tomography pulmonary angiography in 52.63% to 60% of suspected cases.

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