BACKGROUND: Pulmonary embolism (PE) remains one of the most challenging diagnoses in emergency medicine. The Pulmonary Embolism Rule-out Criteria (PERC) score, a decision aid to reliably distinguish low-risk from very low-risk PE patients, has been derived and validated. CLINICAL QUESTION: Can a subset of patients with sufficiently low risk for PE be identified who require no diagnostic testing? EVIDENCE REVIEW: The PERC score derivation and validation trials were located using PubMed and Web of Science. A critical appraisal of this research is presented. RESULTS: One single-center and another multi-center validation trial both confirmed that the eight-item PERC score identified a very low-risk subset of patients in whom PE was clinically contemplated with a negative likelihood ratio 0.17 (95% confidence interval 0.11-0.25) in the larger trial. If applied, the rule would have identified 20% of potential PE patients as very low risk. CONCLUSION: The PERC score provides clinicians with an easily remembered, validated clinical decision rule that allows physicians to forego diagnostic testing for pulmonary embolus in a very low-risk population.
BACKGROUND:Pulmonary embolism (PE) remains one of the most challenging diagnoses in emergency medicine. The Pulmonary Embolism Rule-out Criteria (PERC) score, a decision aid to reliably distinguish low-risk from very low-risk PE patients, has been derived and validated. CLINICAL QUESTION: Can a subset of patients with sufficiently low risk for PE be identified who require no diagnostic testing? EVIDENCE REVIEW: The PERC score derivation and validation trials were located using PubMed and Web of Science. A critical appraisal of this research is presented. RESULTS: One single-center and another multi-center validation trial both confirmed that the eight-item PERC score identified a very low-risk subset of patients in whom PE was clinically contemplated with a negative likelihood ratio 0.17 (95% confidence interval 0.11-0.25) in the larger trial. If applied, the rule would have identified 20% of potential PE patients as very low risk. CONCLUSION: The PERC score provides clinicians with an easily remembered, validated clinical decision rule that allows physicians to forego diagnostic testing for pulmonary embolus in a very low-risk population.
Authors: Christopher R Carpenter; Bryan G Kane; Merle Carter; Raymond Lucas; Lee G Wilbur; Charles S Graffeo Journal: Acad Emerg Med Date: 2010-10 Impact factor: 3.451
Authors: Andrew Worster; Kulamakan Kulasegaram; Christopher R Carpenter; Teresa Vallera; Suneel Upadhye; Jonathan Sherbino; R Brian Haynes Journal: Acad Emerg Med Date: 2011-11 Impact factor: 3.451