Differentiating Low-Risk and No-Risk PE Patients: The PERC Score

Carpenter, Christopher R.; Keim, Samuel M.; Seupaul, Rawle A.; Pines, Jesse M.

doi:10.1016/j.jemermed.2008.06.017

Cited by 12 publications

(7 citation statements)

References 14 publications

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“…When applied to a sample of unselected patients with an overall PE prevalence of 26%, 6.7% of PERC (−) patients had PE, a proportion that is unacceptably high [13]. It has therefore been suggested that the PERC rule should be applied only to patients at a very low risk for PE, which requires the application of another PE clinical decision rule [14].…”

Section: Introductionmentioning

confidence: 99%

The pulmonary embolism rule‐out criteria (PERC) rule does not safely exclude pulmonary embolism

Hügli

Righini

Gal

et al. 2011

Journal of Thrombosis and Haemostasis

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Summary. Background: The Pulmonary Embolism Rule-out Criteria (PERC) rule is a clinical diagnostic rule designed to exclude pulmonary embolism (PE) without further testing. We sought to externally validate the diagnostic performance of the PERC rule alone and combined with clinical probability assessment based on the revised Geneva score. Methods: The PERC rule was applied retrospectively to consecutive patients who presented with a clinical suspicion of PE to six emergency departments, and who were enrolled in a randomized trial of PE diagnosis. Patients who met all eight PERC criteria [PERC ()) ] were considered to be at a very low risk for PE. We calculated the prevalence of PE among PERC ()) patients according to their clinical pretest probability of PE. We estimated the negative likelihood ratio of the PERC rule to predict PE. Results: Among 1675 patients, the prevalence of PE was 21.3%. Overall, 13.2% of patients were PERC ()) . The prevalence of PE was 5.4% [95% confidence interval (CI): 3.1-9.3%] among PERC ()) patients overall and 6.4% (95% CI: 3.7-10.8%) among those PERC ()) patients with a low clinical pretest probability of PE. The PERC rule had a negative likelihood ratio of 0.70 (95% CI: 0.67-0.73) for predicting PE overall, and 0.63 (95% CI: 0.38-1.06) in low-risk patients. Conclusions: Our results suggest that the PERC rule alone or even when combined with the revised Geneva score cannot safely identify very low risk patients in whom PE can be ruled out without additional testing, at least in populations with a relatively high prevalence of PE.

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Section: Introductionmentioning

confidence: 99%

The pulmonary embolism rule‐out criteria (PERC) rule does not safely exclude pulmonary embolism

Hügli

Righini

Gal

et al. 2011

Journal of Thrombosis and Haemostasis

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“…However, this element—the history of the present illness—will help inform the pretest likelihood of a given patient’s having appendicitis, as the clinician determines the threshold for further testing. The concept of constructing a pretest likelihood from various relatively nonspecific risk factors to determine further testing is well known from the diagnostic algorithms for diseases such as pulmonary embolism and deep vein thrombosis 8,9. We think that taken in the context of the rest of the clinical signs and symptoms, a family history will add modestly to the clinical gestalt of the patient when there is diagnostic uncertainty, especially when CT is not routinely unavailable.…”

Section: Discussionmentioning

confidence: 99%

Family History is a Predictor for Appendicitis in Adults in the Emergency Department

Drescher¹,

Marcotte²,

Grant³

et al. 2012

WestJEM

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Introduction:A family history of appendicitis has been reported to increase the likelihood of the diagnosis in children and in a retrospective study of adults. We compare positive family history with the diagnosis of acute appendicitis in a prospective sample of adults.Methods:We conducted a prospective observational study of a convenience sample of 428 patients. We compared patients with surgically proven appendicitis to a group without appendicitis. The latter were further grouped by their presenting symptoms: those presenting with a chief complaint of abdominal pain and those with other chief complaints. Participants answered questions regarding their family history of appendicitis. Family history was then compared for the appendicitis group versus the nonappendicitis group as a whole, and then versus the subgroup of patients without appendicitis but with abdominal pain. The primary analysis was a χ2 test of proportions and the calculation of odds ratio (OR) for the relationship between final diagnosis of appendicitis and family history.Results:Of 428 patients enrolled, 116 had appendicitis. Of those with other diagnoses, 158 had abdominal pain and 154 had other complaints. Of all patients with appendicitis, 37.9% (confidence interval [Cl] = 29.1–46.8) had positive family history. Of those without appendicitis, 23.7% (Cl = 19.0–28.4) had positive family history. In the subgroup without appendicitis but with abdominal pain, 25.9% (Cl = 19.1–32.8) had positive family history. Both comparisons were significant (P = 0.003; OR = 1.97; 95% Cl = 1.2–3.1; and P=0.034; OR = 1.74; 95% Cl = 1.04–2.9, respectively). By multivariate logistic regression analysis across the full sample, family history was a significant independent predictor (P = 0.011; OR = 1.883) of appendicitis.Conclusion:Adults presenting to the emergency department with a known family history of appendicitis are more likely to have this disease than those without.

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“…Multiple programs archive their journal club–derived critically appraised topics for public access on the Internet 39,40 . One of these programs has published the results of its journal club infrastructure, instructional instruments, and final product reviews in the EM literature 17,41–46 . These archives serve the function of internally developed secondary sources, and the websites include links to free online statistical calculators, external secondary peer‐reviewed synopses, and other institutions’ EBM curricula 47 .…”

Section: Discussionmentioning

confidence: 99%

Incorporating Evidence‐based Medicine into Resident Education: A CORD Survey of Faculty and Resident Expectations

Carpenter

Kane

Carter

et al. 2010

Academic Emergency Medicine

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Background The Accreditation Council for Graduate Medical Education (ACGME) invokes evidence-based medicine (EBM) principles through the practice-based learning core competency. The authors hypothesized that among a representative sample of emergency medicine (EM) residency programs, a wide variability in EBM resident training priorities, faculty expertise expectations, and curricula exists. Objectives The primary objective was to obtain descriptive data regarding EBM practices and expectations from EM physician educators. Our secondary objective was to assess differences in EBM educational priorities among journal club directors compared with non–journal club directors. Methods A 19-question survey was developed by a group of recognized EBM curriculum innovators and then disseminated to Council of Emergency Medicine Residency Directors (CORD) conference participants, assessing their opinions regarding essential EBM skill sets and EBM curricular expectations for residents and faculty at their home institutions. The survey instrument also identified the degree of interest respondents had in receiving a free monthly EBM journal club curriculum. Results A total of 157 individuals registered for the conference, and 98 completed the survey. Seventy-seven (77% of respondents) were either residency program directors or assistant / associate program directors. The majority of participants were from university-based programs and in practice at least 5 years. Respondents reported the ability to identify flawed research (45%), apply research findings to patient care (43%), and comprehend research methodology (33%) as the most important resident skill sets. The majority of respondents reported no formal journal club or EBM curricula (75%) and do not utilize structured critical appraisal instruments (71%) when reviewing the literature. While journal club directors believed that resident learners’ most important EBM skill is to identify secondary peer-reviewed resources, non–journal club directors identified residents’ ability to distinguish significantly flawed research as the key skill to develop. Interest in receiving a free monthly EBM journal club curriculum was widely accepted (89%). Conclusions Attaining EBM proficiency is an expected outcome of graduate medical education (GME) training, although the specific domains of anticipated expertise differ between faculty and residents. Few respondents currently use a formalized curriculum to guide the development of EBM skill sets. There appears to be a high level of interest in obtaining EBM journal club educational content in a structured format. Measuring the effects of providing journal club curriculum content in conjunction with other EBM interventions may warrant further investigation.

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Differentiating Low-Risk and No-Risk PE Patients: The PERC Score

Cited by 12 publications

References 14 publications

The pulmonary embolism rule‐out criteria (PERC) rule does not safely exclude pulmonary embolism

The pulmonary embolism rule‐out criteria (PERC) rule does not safely exclude pulmonary embolism

Family History is a Predictor for Appendicitis in Adults in the Emergency Department

Incorporating Evidence‐based Medicine into Resident Education: A CORD Survey of Faculty and Resident Expectations

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