title: Performance of the Pulmonary Embolism Rule-out Criteria (the PERC rule) combined with low clinical probability in high prevalence population.
abstract: BACKGROUND
  PERC rule was created to rule out pulmonary embolism (PE) without further exams, with residual PE risk<2%. Its safety is currently not confirmed in high PE prevalence populations even when combined with low clinical probability assessed by revised Geneva score (RGS). As PERC rule and RGS are 2 similar explicit rules with many redundant criteria, we hypothesized that the combination of PERC rule with gestalt clinical probability could resolve this limitation.
  
  
  METHODS
  We collected prospectively documented clinical gestalt assessments and retrospectively calculated PERC rules and RGS from a prospective study of PE suspected patients. We analyzed performance of combinations of negative PERC with low clinical probability assessed by both methods in high overall PE prevalence population.
  
  
  RESULTS
  Among the final study population (n = 959), the overall PE prevalence was 29.8%. Seventy-four patients (7.7%) were classified as PERC negative and among them, 4 patients (5.4%) had final diagnosis of PE. When negative PERC was combined with low pretest probability assessed by RGS or gestalt assessment, PE prevalence was respectively 6.2% and 0%. This last combination reaches threshold target of 2% and unnecessary exams could easily have been avoided in this subgroup (6%). However, it confidence interval was still wide (0%; CI 0-5).
  
  
  CONCLUSIONS
  PERC rule combined with low gestalt probability seems to identify a group of patients for whom PE could easily be ruled out without additional test. A larger study is needed to confirm this result and to ensure safety.
authors.affiliation: Emergency Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium. andrea.penaloza@uclouvain.be
authors.forename: Andrea
authors.initials: A
authors.lastname: Penaloza
authors.forename: Franck
authors.initials: F
authors.lastname: Verschuren
authors.forename: Sophie
authors.initials: S
authors.lastname: Dambrine
authors.forename: Francis
authors.initials: F
authors.lastname: Zech
authors.forename: Frédéric
authors.initials: F
authors.lastname: Thys
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Roy
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D006801:Humans; D015995:Prevalence; D011336:Probability; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012189:Retrospective Studies