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eWellness: PERC rule for pulmonary embolism

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Dr KK Aggarwal    28 May 2018

PERC is a tool that rules out pulmonary embolism (PE) and is an alternate to sensitive D-dimer testing in patients with a low-probability assessment for PE. It is best used in patients who present to the emergency department (ED) with dyspnea or chest pain, in whom the gestalt estimate pre-test probability for PE is less than 15%. It is not meant for risk stratification.

The PERC rule has 8 criteria:

  1. Age <50 years
  2. Heart rate <100 beats/minute
  3. Oxyhemoglobin saturation ≥95%
  4. No hemoptysis
  5. No estrogen use
  6. No prior DVT or PE
  7. No unilateral leg swelling
  8. No surgery/trauma requiring hospitalization within the prior 4 weeks

In patients with a low probability of PE who fulfill all the above 8 criteria, the likelihood of PE is low and no further testing is required.

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