The Pulmonary Embolism Rule-Out Criteria rule in a community hospital ED: a retrospective study of its potential utility

Dachs, Robert; Kulkarni, Divya; Higgins, George L.

doi:10.1016/j.ajem.2010.05.018

Cited by 22 publications

(16 citation statements)

References 12 publications

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“…In all, 12 studies including 13 cohorts met the inclusion criteria (table 1), comprising of 14 844 patients from six countries (USA, UK, Switzerland, France, Belgium and New Zealand) 4–11 13 16–18. Twelve cohorts were urban and one was rural,5 with three derived retrospectively,6 10 13 while the rest were derived prospectively. Mean age was 56.7 years, with 63% female subjects.…”

Section: Resultsmentioning

confidence: 99%

Pulmonary embolism rule-out criteria (PERC) in pulmonary embolism—revisited: A systematic review and meta-analysis

et al. 2012

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ObjectivesTo perform a systematic review and meta-analysis including all the current studies to assess the accuracy of pulmonary embolism rule-out criteria (PERC) in ruling out pulmonary embolism (PE).MethodsWe conducted a comprehensive search of the major databases (Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycInfo, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews and Scopus) and references of potentially eligible articles and conference proceedings of major emergency medicine organisations through May 2012. We included all original research studies conducted in emergency departments on diagnostic performance of PERC. Two reviewers independently identified the eligible studies and extracted data. Sensitivity, specificity and likelihood ratios were calculated using contingency tables.Results12 studies including 13 cohorts (three retrospective, 10 prospective) were included, comprising of 14 844 patients from six countries. 12 cohorts were urban and one was rural. Pooled (95% CI) sensitivity, specificity, positive and negative likelihood ratio were 0.97 (0.96 to 0.98), 0.22 (0.22 to 0.23), 1.22 (1.16 to 1.29) and 0.17 (0.13 to 0.23), respectively. The pooled (95% CI) diagnostic OR was 7.4 (5.5–9.8). On meta-regression analysis, there was no significant difference between PE prevalence and PERC diagnostic performance (coefficient (SE) of −0.032 (0.022), p=0.173) or on relative diagnostic OR (0.97, 95% CI 0.92 to 1.02). Significant heterogeneity was observed in specificity (I2=97.4%) and positive likelihood ratio (I2=89.1%).ConclusionsBecause of the high sensitivity and low negative likelihood ratio, PERC rule can be used confidently in clinically low probability population settings.

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Section: Resultsmentioning

confidence: 99%

Pulmonary embolism rule-out criteria (PERC) in pulmonary embolism—revisited: A systematic review and meta-analysis

et al. 2012

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“…30,31 Last, a 2012 Class II meta-analysis that included 13,885 low-risk patients with a 10% prevalence of PE found the PERC to be adequate to exclude the diagnosis of PE in a low-risk population. 32 Their analysis included 8 patient cohorts that were not included in this clinical policy (3 with abstract data only, 33-35 4 graded Class X, [36][37][38][39] and 1 nonapplicable cohort included in the original Kline et al 24 derivation study). The meta-analysis found a pooled sensitivity, specificity, and negative likelihood ratio of 97%, 23%, and 0.18, respectively.…”

Section: Perc Performance In Low-risk Cohortsmentioning

confidence: 99%

Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease

Wolf¹,

Hahn²,

Nentwich³

et al. 2018

Annals of Emergency Medicine

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“…A series of retrospective and prospective validation studies demonstrated that PERC (−) patients have a risk of PE varying between 0% and 1.4% [8–11]. However, these validation studies included selected patients who were at low risk for PE (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…However, these validation studies included selected patients who were at low risk for PE (e.g. patients with a low probability of PE based on physician assessment or with pleuritic chest pain only) or were limited by a small sample size [8–11]. More importantly, the prevalence of PE only varied between 5.3% and 12% in these studies [8–12].…”

Section: Introductionmentioning

confidence: 99%

“…patients with a low probability of PE based on physician assessment or with pleuritic chest pain only) or were limited by a small sample size [8–11]. More importantly, the prevalence of PE only varied between 5.3% and 12% in these studies [8–12]. When applied to a sample of unselected patients with an overall PE prevalence of 26%, 6.7% of PERC (−) patients had PE, a proportion that is unacceptably high [13].…”

Section: Introductionmentioning

confidence: 99%

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The pulmonary embolism rule‐out criteria (PERC) rule does not safely exclude pulmonary embolism

Hügli

Righini

Gal

et al. 2011

Journal of Thrombosis and Haemostasis

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Summary. Background: The Pulmonary Embolism Rule-out Criteria (PERC) rule is a clinical diagnostic rule designed to exclude pulmonary embolism (PE) without further testing. We sought to externally validate the diagnostic performance of the PERC rule alone and combined with clinical probability assessment based on the revised Geneva score. Methods: The PERC rule was applied retrospectively to consecutive patients who presented with a clinical suspicion of PE to six emergency departments, and who were enrolled in a randomized trial of PE diagnosis. Patients who met all eight PERC criteria [PERC ()) ] were considered to be at a very low risk for PE. We calculated the prevalence of PE among PERC ()) patients according to their clinical pretest probability of PE. We estimated the negative likelihood ratio of the PERC rule to predict PE. Results: Among 1675 patients, the prevalence of PE was 21.3%. Overall, 13.2% of patients were PERC ()) . The prevalence of PE was 5.4% [95% confidence interval (CI): 3.1-9.3%] among PERC ()) patients overall and 6.4% (95% CI: 3.7-10.8%) among those PERC ()) patients with a low clinical pretest probability of PE. The PERC rule had a negative likelihood ratio of 0.70 (95% CI: 0.67-0.73) for predicting PE overall, and 0.63 (95% CI: 0.38-1.06) in low-risk patients. Conclusions: Our results suggest that the PERC rule alone or even when combined with the revised Geneva score cannot safely identify very low risk patients in whom PE can be ruled out without additional testing, at least in populations with a relatively high prevalence of PE.

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The Pulmonary Embolism Rule-Out Criteria rule in a community hospital ED: a retrospective study of its potential utility

Cited by 22 publications

References 12 publications

Pulmonary embolism rule-out criteria (PERC) in pulmonary embolism—revisited: A systematic review and meta-analysis

Pulmonary embolism rule-out criteria (PERC) in pulmonary embolism—revisited: A systematic review and meta-analysis

Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease

The pulmonary embolism rule‐out criteria (PERC) rule does not safely exclude pulmonary embolism

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