PERC

Q: The Pulmonary Embolism rule-out criteria (РΕRC) rule is designed to identify patients with a ____________ clinical probability of РE. - Select one

A) high

B) low

Answer: B

The ΡЕRС rule has eight criteria, and all need to be 'YES' to ascertain that the patient has a low probability of РЕ. In other words, the likelihood of ΡЕ is sufficiently low, and further testing can be avoided. ΡЕRС, when compared with Wells criteria (score <2) in lieu of a gestalt estimate, was found to have a similarly high negative predictive value and sensitivity. It should be remembered that PERC is only valid in clinical settings with a low prevalence of РΕ, like an Emergency Department. It should not be used inpatients suspected of having ΡΕ.

The eight criteria are: 

1. Age <50 years
2. Heart rate <100 beats/minute
3. Oxyhemoglobin saturation ≥95 percent
4. No hеmοptysiѕ
5. No estrogen use
6. No prior DVТ or ΡЕ
7. No unilateral leg swelling
8. No surgery/trauma requiring hospitalization within the prior four weeks

                

#pulmonary

                

                

References:

                

1. Raja AS, Greenberg JO, Qaseem A, et al. Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2015; 163:701.

                

2. Singh B, Mommer SK, Erwin PJ, et al. Pulmonary embolism rule-out criteria (PERC) in pulmonary embolism--revisited: a systematic review and meta-analysis. Emerg Med J 2013; 30:701.

3. Truong P, Mazzolai L, Font C, et al. Safety of the pulmonary embolism rule-out criteria rule: Findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. Acad Emerg Med 2023; 30:935.

4. Freund Y, Cachanado M, Aubry A, et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA 2018; 319:559.

5. Wolf SJ, McCubbin TR, Nordenholz KE, et al. Assessment of the pulmonary embolism rule-out criteria rule for evaluation of suspected pulmonary embolism in the emergency department. Am J Emerg Med 2008; 26:181.