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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.
This was a cross-sectional study performed at Kalafong Provincial Tertiary Hospital Department of Radiology. In-patients presenting with suspected pulmonary embolism in the pregnancy and puerperal periods who underwent CT pulmonary angiogram at Kalafong Provincial Tertiary Hospital Radiology Department from 1 June 2017 to 1 June 2020 were considered for the study. A list of patients who underwent CT pulmonary angiograms in the stipulated time frame was compiled from the Phillips Intellispace portal (ISP) study list. Corresponding electronic reports were available from March 2019 onwards on the ISP. Studies performed prior to this were accessed from the printed and filed reports at the Kalafong Department of Radiology and were physically reviewed in the department. The study list was then abbreviated to include only patients during the pregnancy and puerperal periods who met the inclusion criteria. Patient files were reviewed on site and D-dimer results were retrieved from the national health laboratory service (NHLS) online portal using the patient’s demographic information available from the patient study list. The pregnancy-adapted YEARS algorithm used to aid clinical decision making is detailed in Figure 1. The pregnancy-adapted YEARS algorithm uses a step wise approach based on clinical findings, D-dimer values and compression ultrasonography to guide clinicians as to whether further radiological workup with CT pulmonary angiogram is necessary. Pregnancy-adapted YEARS algorithm. A retrospective comparison was made with regard to the CTPA outcome and the pregnancy-adapted YEARS algorithm criteria. Patient demographic and clinical information was tabulated, in addition to the outcome of their CT pulmonary angiogram and D-dimer levels during hospital stay using Google Sheets. Clinical information required included: For quantitative measurement, CT report findings were assigned Boolean values: Patients were further categorised according to the pregnancy-adapted YEARS algorithm as either: The research was approved by the Ethics Review Panel of the University of Pretoria (REC #377/2021) prior to data collection. Permission was also granted by the medical manager of Kalafong Provincial Tertiary Hospital to access patient records and radiological investigations.
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