PERC rule: Difference between revisions
Ostermayer (talk | contribs) (Text replacement - " PE " to " PE ") |
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==Background== | ==Background== | ||
* | *Pulmonary Embolism Rule-out Criteria — used to identify patients in whom [[pulmonary embolism]] can be excluded ''without'' D-dimer testing | ||
*If | *'''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}} | {{PERC rule}} | ||
==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== | ==Validation== | ||
*Validated on | *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 | |||
* | |||
==See Also== | ==See Also== | ||
*[[Pulmonary embolism]] | |||
*[[Wells criteria]] | |||
*[[D-dimer]] | |||
*[[EBQ:PERC Rule Validation]] | *[[EBQ:PERC Rule Validation]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pulmonary]] | [[Category:Pulmonary]] | ||
[[Category:Vascular]] | |||
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
See Also
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).