Original Research

The effectiveness of the pregnancy adapted YEARS algorithm to safely identify patients for CT pulmonary angiogram in pregnant and puerperal patients suspected of having pulmonary embolism

Riaan Potgieter, Piet Becker, Farhana Suleman
South African Journal of Radiology | Vol 26, No 1 | a2454 | DOI: https://doi.org/10.4102/sajr.v26i1.2454 | © 2022 Riaan Potgieter, Piet Becker, Farhana Suleman | This work is licensed under CC Attribution 4.0
Submitted: 15 April 2022 | Published: 29 July 2022

About the author(s)

Riaan Potgieter, Department of Diagnostic Radiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Piet Becker, Department of Statistics, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Farhana Suleman, Department of Diagnostic Radiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa


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Abstract

Background: Pulmonary thromboembolism is one of the leading causes of maternal death worldwide. Globally there has been increasing physician reliance on CT pulmonary angiogram for definitive diagnoses and exclusion of pulmonary thromboembolism. The problem, however, arises when considering the high radiation penalty from performing these investigations, highlighted by the low diagnostic yield. Of recent, the pregnancy-adapted YEARS algorithm has shown promise in international studies as a possible alternative for stratifying risk of pulmonary thromboembolism during the pregnancy and puerperal period.

Objectives: To determine the effectiveness of the pregnancy adapted YEARS algorithm to safely minimise the number of true negative CT pulmonary angiograms for patients suspected of having pulmonary embolism in our clinical setting.

Method: A cross-sectional study was performed in a tertiary hospital in Gauteng on puerperal and pregnant patients suspected of having pulmonary embolism. We retrospectively applied the pregnancy adapted YEARS algorithm and reviewed the various outcomes.

Results: The pregnancy adapted YEARS algorithm proved effective in safely identifying patients for CT pulmonary angiography. By retrospectively applying the algorithm, there could have been a 25.7% scan reduction, whilst maintaining a negative predictive value of 100.0%.

Conclusion: As physician reliance on radiological investigations increases, we must remain cognisant of the added radiation exposure and the long-term adverse effects of ionising radiation. The pregnancy-adapted YEARS algorithm provides a safe, reproducible alternative to aid our bid going forward.


Keywords

pulmonary embolism; CT pulmonary angiogram; pregnancy-adapted YEARS algorithm; radiation safety; pregnancy; puerperium; persistent tachycardia; breast cancer

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