Prospective multicenter evaluation of the pulmonary embolism rule‐out criteria

@article{Kline2008ProspectiveME,
  title={Prospective multicenter evaluation of the pulmonary embolism rule‐out criteria},
  author={Jeffrey A. Kline and Daniel Mark Courtney and Christopher Kabrhel and Christopher L. Moore and Howard A Smithline and Michael C. Plewa and Peter Richman and Brian O'Neil and Kristen E. Nordenholz},
  journal={Journal of Thrombosis and Haemostasis},
  year={2008},
  volume={6}
}
Summary.  Backgound: Over‐investigation of low‐risk patients with suspected pulmonary embolism (PE) represents a growing problem. The combination of gestalt estimate of low suspicion for PE, together with the PE rule‐out criteria [PERC(−): age < 50 years, pulse < 100 beats min−1, SaO2 ≥ 95%, no hemoptysis, no estrogen use, no surgery/trauma requiring hospitalization within 4 weeks, no prior venous thromboembolism (VTE), and no unilateral leg swelling], may reduce speculative testing for PE. We… Expand

Paper Mentions

Interventional Clinical Trial
Utilization of diagnostic imaging in the Emergency Department has increased dramatically over the past two decades, driven by an increased availability of advanced imaging, legal… Expand
ConditionsBrain Injuries, Pulmonary Embolism
InterventionBehavioral
The pulmonary embolism rule‐out criteria (PERC) rule does not safely exclude pulmonary embolism
TLDR
The results suggest that the PERC rule alone or even when combined with the revised Geneva score cannot safely identify very low risk patients in whom PE can be ruled out without additional testing, at least in populations with a relatively high prevalence of PE. Expand
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TLDR
It is suggested that in patients with high PTP of PE, neither negative CTPA by itself nor anegative CTPA plus a negative D-dimer are sufficient to rule out PE and more aggressive workup strategies may be required for these patients. Expand
Pulmonary Embolism Testing Among Emergency Department Patients Who Are Pulmonary Embolism Rule‐out Criteria Negative
TLDR
In an academic ED, a significant proportion of PERC-negative patients underwent testing for PE, including CT or VQ scan without D-dimer risk stratification, and factors associated with PE testing in PERC -negative patients included age, white non-Hispanic race/ethnicity, pleuritic chest pain, and a complaint of both chest pain and shortness of breath. Expand
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TLDR
The PROPER trial was a cluster-randomized clinical trial conducted at 14 centers in France that tested the effect of a clinical prediction rule, using only clinical criteria, to exclude acute pulmonary embolism (PE) at the bedside among low-risk emergency department patients. Expand
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TLDR
D-dimer adjustment based on PTP may result in a reduced need for imaging to evaluate possible PE, with some additional missed PE but no decrease in NPV. Expand
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TLDR
Using PERC could have safely avoided 11.5% of CTAs, reducing potential patient harm, health care costs, and unnecessary diagnostic testing, and consistent with prior studies, PERC can be safely used to identify low-risk patients for whom further testing can be deferred. Expand
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TLDR
It is hypothesized that in European patients with a low gestalt clinical probability and who are PERC-negative, PE can be safely ruled out and the patient discharged without further testing, and the PROPER study should provide high-quality evidence to settle this issue. Expand
Detection of Pulmonary Embolism in High-Risk Children.
TLDR
The risk of PE is low among children not receiving estrogen therapy and without tachycardia and hypoxia in those with an initial suspicion of PE, and application of the PERC rule and Wells criteria should be used cautiously in the pediatric population. 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
Evaluation of the pulmonary embolism rule out criteria (PERC rule) in children evaluated for suspected pulmonary embolism.
TLDR
In this sample of children and teenagers with suspected PE, the PERC rule was negative in 31%, and demonstrated good overall diagnostic accuracy, including a low false negative rate, which supports the need for a large, prospective diagnostic validation study of PERC in children. Expand
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