PERC rule: Difference between revisions

Latest revision as of 01:40, 21 March 2026

Background

Pulmonary Embolism Rule-out Criteria — used to identify patients in whom pulmonary embolism can be excluded without D-dimer testing
Only apply if clinical gestalt for PE is low (i.e., you would be confident PE is excluded with a negative D-dimer)
If ALL 8 criteria are met in a low-risk patient, no further workup is needed (negative predictive value >99%)

Criteria

PERC Rule Calculator

Check all of the following that are true:

Age <50yr
Pulse ox >94% (room air)
HR <100
No prior PE or DVT
No recent surgery or trauma (within prior 4wk)
No hemoptysis
No estrogen use
No unilateral leg swelling

In patients with low suspicion for PE (best-guess pre-test probability <15%) AND all are true, only 0.9% had PE (n=7527) and it can be ruled-out without further testing (i.e. no need for d-dimer)^[1]^[2]

Application

Step 1: Assess clinical probability (gestalt or Wells criteria)
Step 2: If low probability (Wells ≤4), apply PERC
Step 3: If all PERC criteria met → stop workup; no D-dimer needed
Step 4: If any PERC criterion NOT met → obtain D-dimer
Do NOT apply PERC in moderate or high pre-test probability patients

Validation

Validated on 8,138 patients across 13 EDs
Missed PE rate when PERC-negative with low gestalt: <2% (below the testing threshold)
No PE-related deaths in PERC-negative group at 45-day follow-up

References

↑ Kline JA, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2: 1247–55.
↑ Kline JA, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008; 6: 772–80. (PMID: 18318689).

Authors:

[1] Kline JA, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2: 1247–55.

[2] Kline JA, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008; 6: 772–80. (PMID: 18318689).

[1]

[2]

@@ Line 1: / Line 1: @@
-Pulmonary Embolism Rule Out (PERC) Criteria
+==Background==
+*Pulmonary Embolism Rule-out Criteria — used to identify patients in whom [[pulmonary embolism]] can be excluded ''without'' D-dimer testing
+*'''Only apply if clinical gestalt for PE is low''' (i.e., you would be confident PE is excluded with a negative D-dimer)
+*If ALL 8 criteria are met in a low-risk patient, no further workup is needed (negative predictive value >99%)
-If all BREATHS are present AND low suspicion for PE, no D-dimer needed:
+==Criteria==
+{{PERC rule}}
-B- No blood in sputum
+==Application==
+*'''Step 1:''' Assess clinical probability (gestalt or [[Wells criteria]])
+*'''Step 2:''' If low probability (Wells ≤4), apply PERC
+*'''Step 3:''' If all PERC criteria met → stop workup; no D-dimer needed
+*'''Step 4:''' If any PERC criterion NOT met → obtain [[D-dimer]]
+*'''Do NOT apply PERC''' in moderate or high pre-test probability patients
-R- room air sat > 95%
+==Validation==
+*Validated on 8,138 patients across 13 EDs
+*Missed PE rate when PERC-negative with low gestalt: <2% (below the testing threshold)
+*No PE-related deaths in PERC-negative group at 45-day follow-up
-E- No estrogen or hormone use
+==See Also==
+*[[Pulmonary embolism]]
+*[[Wells criteria]]
+*[[D-dimer]]
+*[[EBQ:PERC Rule Validation]]
-A- Age < 50
+==References==
+<references/>
-T- No  prior DVT or PE
+[[Category:Pulmonary]]
+[[Category:Vascular]]
-H- Heart rate < 100bpm
-S- No surgery/trauma requiring hospitalization in past 4 weeks
-Note: Inclusion Criteria
-Use this criteria if confident in excluding PE with negative D-dimer
-Patient with dyspnea and PE was not felt to be the most likely Dx:
-     -very low risk group ~2% overall PE risk
-Note: Exclusion
-DO NOT use if negative D-dimer does not r/o PE
-Validated on 7527 patients found 96% sensitive in detecting PE
-.9% had PE, 0 died when all BREATHS present
-[[Category:Pulm]]