This clinical policy provides evidence-based recommendations supporting the use of the PERC rule in low-risk patients and age-adjusted D-dimer thresholds in patients over 50 to safely exclude PE.
Systematic Review
Can the PERC rule or an age-adjusted D-dimer result safely identify adult ED patients at very low risk for pulmonary embolism for whom no additional diagnostic workup is required?
Adult patients presenting to the emergency department with suspected acute venous thromboembolic disease (pulmonary embolism) with low to intermediate pretest probability.
Pulmonary Embolism Rule-out Criteria (PERC) rule for low-risk patients, and age-adjusted D-dimer testing (age x 10 mg/L or age x 5 mg/L depending on assay) for patients older than 50 years.
Conventional diagnostic workup, including clinical gestalt assessment or conventional fixed-cutoff D-dimer testing.
Missed pulmonary embolism (miss rate/failure rate) and diagnostic accuracy (sensitivity, specificity, negative likelihood ratio).
The ACEP clinical policy recommends the use of the PERC rule and age-adjusted D-dimer cutoffs to safely exclude pulmonary embolism in low-to-intermediate risk ED patients, thereby reducing unnecessary imaging and associated harms.
The Pulmonary Embolism Rule-out Criteria (PERC) rule is a validated clinical tool used to rule out pulmonary embolism (PE) in patients who have a low pre-test probability for PE If a patient is deemed low-risk for PE (pre-test probability <15%) and has no positive criteria on the PERC rule, then no further work-up is needed as the patient has <2% chance of PE.
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Brendan Freeman
Staten Island University Hospital
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Brendan Freeman (Mon,) conducted a systematic review in Suspected Acute Venous Thromboembolic Disease (VTE). Clinical prediction rules (PERC), age-adjusted D-dimer, and anticoagulation strategies was evaluated. This clinical policy provides evidence-based recommendations supporting the use of the PERC rule in low-risk patients and age-adjusted D-dimer thresholds in patients over 50 to safely exclude PE.
www.synapsesocial.com/papers/69fd7f65bfa21ec5bbf07e22 — DOI: https://doi.org/10.65357/001c.160870