TY - JOUR T1 - A retrospective analysis of the combined use of PERC rule and Wells score to exclude pulmonary embolism in the Emergency Department JF - Emergency Medicine Journal JO - Emerg Med J SP - 696 LP - 701 DO - 10.1136/emermed-2016-205687 VL - 33 IS - 10 AU - JMG Theunissen AU - C Scholing AU - WE van Hasselt AU - J van der Maten AU - E ter Avest Y1 - 2016/10/01 UR - http://emj.bmj.com/content/33/10/696.abstract N2 - Background The pulmonary embolism rule-out criteria (PERC) rule is an eight-factor decision rule to support the decision not to order a diagnostic test when the gestalt-based clinical suspicion on pulmonary embolism (PE) is low.Methods In a retrospective cohort study, we determined the accuracy of a negative PERC (0) in patients with a low Wells score (<2) to rule-out PE, and compared this to the accuracy of the default algorithm used in our hospital (a low Wells score in combination with a negative D-dimer).Results During the study period, 377 patients with a Wells score <2 were included. CT pulmonary angiography (CTPA) was performed in 86 patients, and V/Q scintigraphy in one patient. PE was diagnosed in 18 patients. 78 patients (21%) had a negative PERC score. When further diagnostic studies would have been omitted in these patients, two (subsegmental) PEs would have been missed, resulting in a sensitivity of 89% (64%–98%) and a negative likelihood ratio (LR−) of 0.52 (0.14–1.97). The default algorithm missed one (subsegmental) PE, resulting in a sensitivity of 95% (71%–99%) and an LR− of 0.25 (0.04–1.73).Conclusions The combination of a Wells score <2 and a PERC rule of 0 had a suboptimal sensitivity for excluding PE in our sample of patients presenting in the ED. Further studies are warranted to test this algorithm in larger populations. ER -