Clinical Decision Rules for PE in the ED
The article: Clinical criteria to prevent unneccesary diagnostic testing in the emergency department patients with suspected pulmonary embolism. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. J Thromb Haemost 2004; 2: 1247-55
The Idea: Using PERC as a clinical decision rule to assist in ruling out PE in the emergency room
The Study: Retrospective analysis on 3,148 ER patients from 10 different ER’s around the country in the patients that had imaging done for suspected diagnosis of PE. There were 21 independent variables identified of the signs/symptoms/risk factors patients had. By logistic regression analysis, this eliminated the list down to 8, the 8 rules we identify as PERC criteria. PERC was then prospectively applied to 1,427 patients who were “low risk” and 382 patients who were “very low risk” (patients who had dyspnea but the ER doctor did not think they had a PE)
The Findings: PERC rule had 96% sensitivity in low risk, 100% in very low risk. Specificity 27% and 15% respectively.
Discussion: The PERC rule is a good tool to help rule out PE in the low risk population. Well’s criteria helps us identify patients that are at high risk for PE, helps guide the need for further testing.