CHAPTER 70 PROSPECTIVE EVALUATION OF THE PERC

Prospective Multicenter Evaluation of the Pulmonary Embolism Rule-out Criteria

Kline JA, Courtney DM, Kabrhel C, et al. J Thromb Haemost. 2008;6(5):772–780

BACKGROUND

Prior to this study, there were no validated clinical decision rules to identify a group at such low risk for pulmonary embolism (PE) that diagnostic testing could be omitted, limiting the risks of radiation, contrast dye exposure, and unnecessary anticoagulation. Existing validated clinical decision tools such as the Wells criteria allowed for low risk rule-out pathways without imaging, but did not obviate the need for laboratory testing. Previous attempts to validate the PERC rule did not yield satisfactory sensitivity, but they did not incorporate the application of clinical gestalt as a part of pre-test risk stratification prior to the application of PERC rules.

OBJECTIVE

To assess the validity of the PERC rule in a subset of patients judged to be at low risk of PE by clinical gestalt.

METHODS

Prospective, observational study of ED patients presenting to 12 centers in the United States and one in New Zealand between July 1, 2003 and November 30, 2006.

Patients

8,138 patients who had a diagnostic test ordered for PE (vascular imaging, ventilation perfusion (V/Q) scan, or D-dimer assay). Patients were enrolled in random 8-hour blocks consecutively at the discretion of the site. Eighty-five percent of patients had a presenting complaint of chest pain or dyspnea.

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