Suspected Pulmonary Embolism Exclusion With D‐Dimers in Emergency Departments: Pregnancy ( SPEED ‐ ED Pregnancy). A Retrospective Evaluation of the Pregnancy‐Adapted YEARS Guideline

OBJECTIVE: To evaluate the safety and effectiveness of the pregnancy-adapted YEARS guideline at a major referral emergency department. METHODS: This was a single-centre, retrospective cohort study of the impact of pregnancy-adapted YEARS guideline at Townsville University Hospital Emergency Department. Pregnant women who presented between July 2018 and June 2025 (2 years before to 5 years after) and were investigated for possible pulmonary embolism (PE) were eligible. Safety was defined as the rate of venous thromboembolism (VTE) at 90 days, and effectiveness as the proportion of women who did not undergo imaging. RESULTS: A total of 532 pregnant women were identified, 76 in the 2 years pre-guideline and 456 in the 5 years post-guideline. Pre-guideline, 24 out of 76 (32%) had D-dimers with no imaging, 36 (47%) had both D-dimers and imaging, 16 (21%) had imaging without D-dimers and there was 1 diagnosed with PE (1.3%). Of the 456 women who presented after guideline introduction, 168 (37%) were evaluated with D-dimers alone, 276 (61%) had D-dimers and imaging, 12 (3%) had imaging without D-dimers and 4 (0.9%) were diagnosed with PE. Of the 168 women post-guideline assessed with D-dimers only, outcome data were available for 150 (89%), none of whom had VTE. CONCLUSIONS: The introduction of the pregnancy-adapted YEARS guideline was associated with increased investigation for PE. Over 5 years, there were no known cases of missed PE.