A retrospective application of the pulmonary embolism rule out criteria (PERC) of the American College of Physicians wou
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ORIGINAL ARTICLE
A retrospective application of the pulmonary embolism rule out criteria (PERC) of the American College of Physicians would reduce the number of CTPAS by 6% without a false negative in an Irish hospital Advait Kothare 1 Peadar Gilligan 2
&
Muath Abahussain 1 & Nikita Svirkov-Vainberg 2 & Patrick O’Kelly 2 & Galamoyo Nfila 2 &
Received: 9 August 2019 / Accepted: 15 October 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background Internationally, the number of computerised tomographic pulmonary angiographies (CTPAs) being performed to rule out pulmonary embolism (PE) has caused some concern. Aim This study was performed to assess if the application of Pulmonary Embolism Rule-out Criteria (PERC) in an Irish Emergency Department (ED) would have helped to safely reduce the number of D-dimer assays and computed tomographic pulmonary angiographies (CTPAs) ordered. Methods The PERC was retrospectively calculated in all patients who underwent CTPA for possible PE. It was then established if the application of the PERC as per the American College of Physicians’ (ACP) guidelines would have safely ruled out the need for further imaging. Results Of the 529 patients who underwent CTPA in the study, 63 patients (12%) had PE on CTPA. Had the PERC criteria been applied, no patient who had a PE would have been missed. In this study, PERC had 100% sensitivity and 14% specificity. Discussion/conclusion Application of the PERC rule, as per the ACP guidelines, would have reduced the number of CTPAs performed by 32 (6%) without missing any patient with a proven pulmonary embolus. Keywords Clinical decision-making tools . CT pulmonary angiography . Diagnostic imaging . PERC . Pulmonary embolism
Introduction * Advait Kothare [email protected] Muath Abahussain [email protected] Nikita Svirkov-Vainberg [email protected] Patrick O’Kelly [email protected] Galamoyo Nfila [email protected] Peadar Gilligan [email protected] 1
Royal College of Surgeons in Ireland, Dublin, Ireland
2
Beaumont Hospital, Dublin, Ireland
Due to the multiple potential presenting symptoms of pulmonary embolism (PE), i.e. dyspnoea, pleuritic chest pain, haemoptysis, and the risk of death, emergency physicians tend to rely heavily on computed tomographic pulmonary angiography (CTPA) when considering this diagnosis [1]. CTPAs have associated risks which include radiation exposure and contrast nephropathy [2]. Validated in a 2008 multi-centre evaluation, the Pulmonary Embolism Rule-out Criteria (PERC) is a checklist that theoretically rules out PE in low-risk patients without the need for imaging [1, 3]. If any of the criteria are present, further investigations are required. There are two major criticisms of the PERC. The first is that, due to its low specificity, it is more effective in populations with lower PE incidence. The safety of using PERC came into question when it was first used in high-prevalence countries in Europe [4]. However, recent studies conducted in
Ir J Med Sci
France and Belgiu
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