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J Emerg Med. 2009 Apr;36(3):317-22. doi: 10.1016/j.jemermed.2008.06.017. Epub 2008 Dec 20.

Differentiating low-risk and no-risk PE patients: the PERC score.

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  • 1Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.

Abstract

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.

PMID:
19097732
[PubMed - indexed for MEDLINE]
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