Eight-item, pulmonary embolism rule-out criteria safe for use with very low risk patients in ER
WEDNESDAY, Feb. 14, 2018 (HealthDay News) — For low risk patients with suspected pulmonary embolism (PE), randomization to eight-item PE rule-out criteria (PERC) seems safe, according to a study published in the Feb. 13 issue of the Journal of the American Medical Association.
Yonathan Freund, M.D., Ph.D., from the Sorbonne Université in Paris, and colleagues conducted a non-inferiority trial in 14 emergency departments in France to validate the safety of PERC-based strategy to rule out PE. A total of 1,916 patients were cluster-randomized: 962 were assigned to the PERC group and 954 to the control group.
The researchers found that a PE was diagnosed at initial presentation in 2.7 percent of patients in the control group, compared with 1.5 percent in the PERC group (difference, 1.3 percent; 95 percent confidence interval, −0.1 to 2.7 percent; P = 0.052). During follow-up, one PE was diagnosed in the PERC group versus none in the control group (difference, 0.1 percent; 95 percent confidence interval, −∞ to 0.8 percent). In the PERC versus the control group, the proportion of patients undergoing computed tomographic pulmonary angiography was 13 versus 23 percent (difference, −10 percent; 95 percent confidence interval, −13 to −6 percent; P < 0.001). Rates were significantly reduced in the PERC group for the median length of emergency department stay and hospital admission.
“These findings support the safety of PERC for very low risk patients presenting to the emergency department,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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