For healthcare professionals
YEARS algorithm calculator
The YEARS algorithm checks 3 items in a patient with suspected pulmonary embolism (PE) and pairs them with a D-dimer test. With no items, a D-dimer below 1000 ng/mL rules PE out; with one or more items, the cutoff is 500 ng/mL. Otherwise CT pulmonary angiography is indicated. This tool is written for clinicians and is not a diagnosis.
Patient details
For adults with suspected acute PE who are not pregnant and not on therapeutic anticoagulation. Nothing you enter leaves this page.
What you will see
The number of YEARS items, the D-dimer cutoff that applies and whether the algorithm rules PE out or calls for imaging.
Educational only, not medical advice. An algorithm does not replace clinical judgment.
Source
The YEARS algorithm by van der Hulle and colleagues, The Lancet 2017 (cited, not quoted), with the items and D-dimer cutoffs as printed in van Maanen and colleagues, BMJ Open 2025 (CC BY 4.0), and cross-checked against Mileto and colleagues, Western Journal of Emergency Medicine 2024 (CC BY 4.0). The tests check each item, both cutoffs and the values exactly at each cutoff.
Validated in
Derived and tested in hospital patients with suspected PE in the YEARS study (van der Hulle 2017). Van Maanen and colleagues tested it in 748 patients with suspected PE in Dutch primary care (median age 55, 70% women; PE prevalence 5.5%). They excluded therapeutic anticoagulation, a life expectancy under 1 month and pregnancy until 6 weeks after delivery.
Limits
Not for pregnant patients: a pregnancy-adapted version exists, but this tool does not apply it. Not for patients already on therapeutic anticoagulation. Clinical judgment comes first: a patient who looks unwell needs assessment whatever the result. D-dimer assays differ; enter the value in the unit your laboratory reports and check with the laboratory if its scale differs. Only values below the cutoff rule PE out; a D-dimer exactly at 500 or 1000 ng/mL does not.
The algorithm, step by step
As printed in van Maanen and colleagues 2025 (van Maanen 2025), from the YEARS study (van der Hulle 2017):
- Score the 3 YEARS items: clinical signs of deep vein thrombosis (DVT), hemoptysis, and PE considered the most likely diagnosis.
- Test the D-dimer in every patient, whatever the number of items.
- No YEARS items: PE is ruled out if the D-dimer is below 1000 ng/mL. A D-dimer above that calls for CT pulmonary angiography (CTPA).
- One or more YEARS items: PE is ruled out if the D-dimer is below 500 ng/mL. A D-dimer above that calls for CTPA.
Mileto and colleagues print the same 3 criteria and the same 2 cutoffs in mg/L: 0.5 mg/L or 1.0 mg/L depending on whether YEARS criteria were met (Mileto 2024). The items are counted, not weighted: one item and three items both use the 500 ng/mL cutoff.
Worked examples: no items and a D-dimer of 750 ng/mL: PE ruled out. Hemoptysis and a D-dimer of 750 ng/mL: CTPA. Signs of DVT and a D-dimer of 450 ng/mL: PE ruled out.
What the studies found
Van Maanen and colleagues summarize the hospital results: the YEARS algorithm cut CTPA use by 14% compared with a fixed D-dimer threshold, and PE was missed in 0.6% of patients (van Maanen 2025).
In their primary care cohort of 748 patients, 603 (80.6%) were classified as PE ruled out: 532 with no items and a D-dimer below 1000 ng/mL, and 71 with one or more items and a D-dimer below 500 ng/mL. Three of the 603 were diagnosed with non-fatal PE within 3 months, a failure rate of 0.50% (95% CI 0.13% to 1.57%). All three had no YEARS items and a D-dimer between 500 and 1000 ng/mL. Of the 145 patients classified as needing imaging, 38 (26.2%) had PE (van Maanen 2025).
Pregnancy
A pregnancy-adapted YEARS algorithm has been studied. Mileto and colleagues reviewed 67 pregnant patients at their health system retrospectively against it (Mileto 2024). This tool does not apply the pregnancy-adapted version.
Related tools
For a points-based pretest probability before D-dimer or imaging, see the Wells score for PE and the revised Geneva score. When the gestalt probability is already low, the PERC rule calculator checks the 8 rule-out criteria without a D-dimer. The 4PEPS score sorts suspected PE into four probability levels, each with its own D-dimer step. Once PE is confirmed, see the PESI score calculator. Other bedside scores are listed under For healthcare professionals. The age-adjusted D-dimer calculator applies the age × 10 cutoff from age 50.
Sources
- van Maanen R, la Roi-Teeuw HM, Rutten FH, et al. YEARS clinical decision rule for diagnosing pulmonary embolism: a prospective diagnostic cohort follow-up study in primary care. BMJ Open. 2025;15(2):e091543. doi:10.1136/bmjopen-2024-091543. Open access (CC BY 4.0). Introduction (the 3 items and the 1000 ng/mL threshold), methods (referral rule and exclusions) and results (748 patients, 603 ruled out, failure rate 0.50%). pmc.ncbi.nlm.nih.gov/articles/PMC11800211/
- Mileto A, Rossi J, Krouse J, et al. Pregnancy-adapted YEARS algorithm: a retrospective analysis. West J Emerg Med. 2024;25(1):136-143. doi:10.5811/westjem.60626. Open access (CC BY 4.0). The 3 YEARS criteria and the 0.5 or 1.0 mg/L D-dimer cutoff (Table 2 and results). pmc.ncbi.nlm.nih.gov/articles/PMC10777188/
- van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet. 2017;390(10091):289-297. doi:10.1016/S0140-6736(17)30885-1. (Derivation of the YEARS algorithm; cited, not quoted.) doi.org/10.1016/S0140-6736(17)30885-1
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-03. Spotted an error? See About.