• Jmg Theunissen, C Scholing, W E van Hasselt, J van der Maten, and E Ter Avest.
• Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
• Emerg Med J. 2016 Oct 1; 33 (10): 696-701.

BackgroundThe pulmonary embolism rule-out criteria (PERC) rule is an eight-factor decision rule to support the decision not to order a diagnostic test when the gestalt-based clinical suspicion on pulmonary embolism (PE) is low.MethodsIn a retrospective cohort study, we determined the accuracy of a negative PERC (0) in patients with a low Wells score (<2) to rule-out PE, and compared this to the accuracy of the default algorithm used in our hospital (a low Wells score in combination with a negative D-dimer).ResultsDuring the study period, 377 patients with a Wells score <2 were included. CT pulmonary angiography (CTPA) was performed in 86 patients, and V/Q scintigraphy in one patient. PE was diagnosed in 18 patients. 78 patients (21%) had a negative PERC score. When further diagnostic studies would have been omitted in these patients, two (subsegmental) PEs would have been missed, resulting in a sensitivity of 89% (64%-98%) and a negative likelihood ratio (LR-) of 0.52 (0.14-1.97). The default algorithm missed one (subsegmental) PE, resulting in a sensitivity of 95% (71%-99%) and an LR- of 0.25 (0.04-1.73).ConclusionsThe combination of a Wells score <2 and a PERC rule of 0 had a suboptimal sensitivity for excluding PE in our sample of patients presenting in the ED. Further studies are warranted to test this algorithm in larger populations.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

20 keywords...

hide…