Journal Club Summary

Methodology Score: 4.5/5
Usefulness Score: 4.5 /5

van der Pol LM, et al. N Engl J Med. 2019 Mar 21;380(12):1139-1149

Question and Methods: Using a prospective cohort study of 510 pregnant women, the authors were trying to see whether an algorithm could safely diagnose PEs and avoid unnecessary imaging.

Findings: YEARS algorithm can safely rule out PE in pregnant women where a negative result has a 0.5% chance of having a PE, avoiding imaging in 32-65% of women depending on trimester.

Limitations: Not an exclusively ED population, results of D-dimer may have been known to physicians and number of protocol violations limit the robustness of the results.

Interpretation: Provides ED physicians with diagnostic clarity on how to investigate pregnant patients suspected of having a PE and whom we can safely discharge home.

By: Dr.  Shawn Chhabra 

Epi Lesson

Did Participating Patients Present a Diagnostic Dilemma?       

Studies of diagnostic tests or decision rules should enroll patients with a spectrum of disease from mild to severe, including many at intermediate risk. If the patients clearly have or do not have the condition of interest, then we will learn very little about how well the new diagnostic test will perform on our undifferentiated ED patients.
By: Dr. Ian Stiell  

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.