EBQ:PERC Rule Validation - Revision history

Danbot: Rename Discussion to Criticisms for EBQ format consistency

2026-03-22T06:10:21Z

Rename Discussion to Criticisms for EBQ format consistency

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	===Secondary Outcomes===		===Secondary Outcomes===

	==~~Discussion~~==		==Criticisms==
	The PERC rule was derived in 2004 with the following criteria. Clinicians should use the rule if the pre-test probability is ≤15% for PE. If any of the following are positive then the risk of PE cannot be estimated to be <2% and further workup is needed.		The PERC rule was derived in 2004 with the following criteria. Clinicians should use the rule if the pre-test probability is ≤15% for PE. If any of the following are positive then the risk of PE cannot be estimated to be <2% and further workup is needed.

Danbot: Added Major Points section

2026-03-21T22:42:41Z

Added Major Points section

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	==Conclusion==		==Conclusion==
	'''The combination of gestalt estimate of low suspicion for PE and PERC(-) reduces the probability of VTE to below 2% in about 20% of outpatients with suspected PE.'''		'''The combination of gestalt estimate of low suspicion for PE and PERC(-) reduces the probability of VTE to below 2% in about 20% of outpatients with suspected PE.'''

			==Major Points==
			*This multicenter validation confirmed that the PERC rule can safely exclude PE without further testing in low-risk patients
			*Among patients with gestalt-estimated low clinical probability and negative PERC, the false-negative rate was 1.0% (below the 2% testing threshold)
			*Approximately 20% of patients evaluated for possible PE can be classified as PERC-negative and low clinical probability
			*Application of the PERC rule in low-risk patients could significantly reduce unnecessary D-dimer testing and CT pulmonary angiography
			*The study reinforced that PERC should only be applied when the pretest probability of PE is already judged to be low (<15%)

	==Overview==		==Overview==

Ostermayer: Text replacement - "Category: Pulm" to "Category:Pulmonary"

2016-03-22T16:11:56Z

Text replacement - "Category: Pulm" to "Category:Pulmonary"

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	*Radecki, R. The PERC Rule Mini-Review. Emergency Medicine Literature of Note. August 23, 2011. Available at: http://www.emlitofnote.com/2011/08/perc-rule-mini-review.html		*Radecki, R. The PERC Rule Mini-Review. Emergency Medicine Literature of Note. August 23, 2011. Available at: http://www.emlitofnote.com/2011/08/perc-rule-mini-review.html

	[[Category: ~~Pulm~~]] [[Category:EBQ]]		[[Category:Pulmonary]] [[Category:EBQ]]

Ostermayer: /* Conclusion */

2014-12-21T02:36:36Z

Conclusion

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 ==Conclusion==
 '''The combination of gestalt estimate of low suspicion for PE and PERC(-) reduces the probability of VTE to below 2% in about 20% of outpatients with suspected PE.'''
 ==Design==
 This was a prospective, non-interventional, multicenter study of patients presenting to the emergency department (ED) in 12 hospitals in the USA and one in Christchurch, New Zealand. Investigators were trained in applying the [[PERC Rule]]

Ostermayer: /* Discussion */

2014-12-21T02:35:21Z

Discussion

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	==Discussion==		==Discussion==
	The PERC rule was derived in 2004 with the following criteria:		The PERC rule was derived in 2004 with the following criteria. Clinicians should use the rule if the pre-test probability is ≤15% for PE. If any of the following are positive then the risk of PE cannot be estimated to be <2% and further workup is needed.

	[[PERC Rule]]:		[[PERC Rule]]:
	#~~Is the patient older than 49 years of age?~~		#Age ≥ 50
	#~~Is the pulse rate above 99 beats min)1?~~		#HR ≥ 100
	#~~Is the pulse oximetry reading~~ <95% ~~while the patient breathes~~ room air?		#O2 Sat < 95% on room air?
	#Is there a present history of hemoptysis?		#Is there a present history of hemoptysis?
	#Is the patient taking exogenous estrogen?		#Is the patient taking exogenous estrogen?

Ostermayer: /* Discussion */

2014-12-21T02:30:01Z

Discussion

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	==Discussion==		==Discussion==
	The PERC rule was derived in 2004 with the		The PERC rule was derived in 2004 with the following criteria:

	[[PERC Rule]]:		[[PERC Rule]]:
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	#Has the patient had recent surgery or trauma? (Requiring endotracheal intubation or hospitalization in the previous 4 weeks.)		#Has the patient had recent surgery or trauma? (Requiring endotracheal intubation or hospitalization in the previous 4 weeks.)
	#Does the patient have unilateral leg swelling? (Visual observation of asymmetry of the calves.)		#Does the patient have unilateral leg swelling? (Visual observation of asymmetry of the calves.)

	~~===Criticism===~~


	==Funding==		==Funding==

Ostermayer: /* CME */

2014-04-03T14:47:02Z

CME

← Revisión anterior		Revisión del 14:47 3 abr 2014
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	Supported by Grants from the National Institutes of Health R41HL074415 and R42HL074415, K23HL077404 and R01 HL074384, and a Medical Student Award from the Emergency Medicine Foundation		Supported by Grants from the National Institutes of Health R41HL074415 and R42HL074415, K23HL077404 and R01 HL074384, and a Medical Student Award from the Emergency Medicine Foundation

	==~~CME~~==		==Review Questions==
	<quiz display=simple>		<quiz display=simple>
	{PERC stands for pulmonary embolism rule out criteria. In this study of 8138 patients, 1666 were found to be low clinical suspicion and PERC negative. The conclusion of the study was		{PERC stands for pulmonary embolism rule out criteria. In this study of 8138 patients, 1666 were found to be low clinical suspicion and PERC negative. The conclusion of the study was

ManpreetS2006: minor edit

2014-01-04T01:38:04Z

minor edit

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	==Outcomes==		==Outcomes==
	8138 patients tested, of which 513 were diagnosed with VTE at the index visit followed by another 47 patients after discharge. Thus, 561 patients (6.9%) were VTE (+). Of the total patients tested, 51% underwent CTA, 12% underwent venous ~~ultrasoun~~ and 6% underwent V/Q scan.		8138 patients tested, of which 513 were diagnosed with VTE at the index visit followed by another 47 patients after discharge. Thus, 561 patients (6.9%) were VTE (+). Of the total patients tested, 51% underwent CTA, 12% underwent venous ultrasound, and 6% underwent V/Q scan.
	===Primary Outcomes===		===Primary Outcomes===
	*1952 (24%) patients were PERC (-) with a sensitivity of 95.7% (95% CI 93.6-97.2%), a specificity of 25.4% (95% CI 24.4-26.4%), and a negative LR of 0.17 (95% CI 0.11-0.25%).		*1952 (24%) patients were PERC (-) with a sensitivity of 95.7% (95% CI 93.6-97.2%), a specificity of 25.4% (95% CI 24.4-26.4%), and a negative LR of 0.17 (95% CI 0.11-0.25%).

ManpreetS2006: New content

2014-01-04T01:36:00Z

New content

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	==Outcomes==		==Outcomes==
			8138 patients tested, of which 513 were diagnosed with VTE at the index visit followed by another 47 patients after discharge. Thus, 561 patients (6.9%) were VTE (+). Of the total patients tested, 51% underwent CTA, 12% underwent venous ultrasoun and 6% underwent V/Q scan.
	===Primary Outcomes===		===Primary Outcomes===
			*1952 (24%) patients were PERC (-) with a sensitivity of 95.7% (95% CI 93.6-97.2%), a specificity of 25.4% (95% CI 24.4-26.4%), and a negative LR of 0.17 (95% CI 0.11-0.25%).
			*1666 (20%) patients were classified as very low risk with a sensitivity of 97.4% (95% CI 95.8-95.5%), a specificity of 21.9% (95% CI 21.0–22.9%), and a negative LR of 0.12 (95% CI 0.07–0.19%).

	===Secondary Outcomes===		===Secondary Outcomes===


	==Discussion==		==Discussion==

ManpreetS2006: Minor edit

2014-01-04T01:12:28Z

Minor edit

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	==Interventions==		==Interventions==
	*72-field, web-based date form completed at the time of test order, which included gestalt pretest probability. Outcomes of image-proven VTE or death from any cause ~~within~~ 45 days.		*72-field, web-based date form completed at the time of test order, which included gestalt pretest probability. Outcomes of image-proven VTE or death from any cause was followed on all enrolled patients at 45 days.

	==Outcomes==		==Outcomes==