Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism

@article{Kline2004ClinicalCT,
  title={Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism},
  author={Jeffrey A. Kline and A. M. Mitchell and Christopher Kabrhel and Peter Richman and Daniel Mark Courtney},
  journal={Journal of Thrombosis and Haemostasis},
  year={2004},
  volume={2}
}
Summary.  Overuse of the d‐dimer to screen for possible pulmonary embolism (PE) can have negative consequences. This study derives and tests clinical criteria to justify not ordering a d‐dimer. The test threshold was estimated at 1.8% using the method of Pauker and Kassirer. The PE rule‐out criteria were derived from logistic regression analysis with stepwise backward elimination of 21 variables collected on 3148 emergency department patients evaluated for PE at 10 US hospitals. Eight variables… Expand

Paper Mentions

Observational Patient Registry Clinical Trial
Decision aids such as the HEART Pathway, Emergency Department Assessment of Chest Pain Score (EDACS), Revised Geneva Score and PERC Score have similar ability to accurately risk… Expand
ConditionsAcute Coronary Syndrome, Pulmonary Embolism
InterventionOther
Effect of the Pulmonary Embolism Rule-Out Criteria on subsequent thromboembolic events among low-risk emergency department patients: the PROPER randomized clinical trial
TLDR
The PROPER trial (PERC Rule to Exclude Pulmonary Embolism in the Emergency Department) is the first randomized clinical trial that has its objective to prospectively validate the safety of PERC in ruling out PE by assessing the percentage of failures of this diagnostic strategy. Expand
Retrospective validation of the pulmonary embolism rule-out criteria rule in ‘PE unlikely’ patients with suspected pulmonary embolism
  • S. Crane, T. Jaconelli, M. Eragat
  • Medicine
  • European journal of emergency medicine : official journal of the European Society for Emergency Medicine
  • 2018
TLDR
The Pulmonary Embolism Rule-Out Criteria (PERC) rule has a high negative predictive value for excluding PE in patients presenting with suspected PE to the ED, however, the PERC rule may still miss around 8% of confirmedPE in patients who are deemed ‘PE unlikely’ by a dichotomized Wells score. Expand
Prospective multicenter evaluation of the pulmonary embolism rule‐out criteria
TLDR
The combination of gestalt estimate of low suspicion for PE and PERC(−) reduces the probability of VTE to below 2% in about 20% of outpatients with suspected PE. Expand
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TLDR
Bivariate analysis showed unilateral leg swelling, recent surgery, and a history of venous thromboembolic event to be predictive of the diagnosis of PE. Expand
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TLDR
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TLDR
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TLDR
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TLDR
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Pulmonary embolism (PE) is a common diagnosis among adult patients presenting to an emergency department (ED) with complaints of chest pain and dyspnea. Pulmonary embolism rule-out criteria (PERC) isExpand
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