PERC Rule - Pulmonary Embolism Rule-Out Criteria-(Charlotte Criteria)

Description

Kline et al developed a rule for avoiding unnecessary diagnostic testing of patients in the Emergency Department suspected of having a pulmonary embolism (PE). The authors are from Carolinas Medical Center in Charlotte, Massachusetts General Hospital, Mayo Clinic Phoenix in Scottsdale and Northwestern Memorial Hospital I Chicago

Patient selection: Emergency Department with suspected pulmonary embolism, but considered low or very low risk by the clinician (a negative D-dimer test sufficient to exclude PE)

Parameters:

(1) age in years

(2) pulse in beats per minute

(3) oxygen saturation in percent on room air by pulse oximetry

(4) cough

(5) hemoptysis

(6) unilateral leg swelling

(7) recent surgery or trauma

(8) history of prior pulmonary embolism (PE) or deep vein thrombosis (DVT)

(9) oral hormone use

(10) asthma, COPD or wheezing

Parameter	Finding	Rule
age in years	< 50 years	0
	>= 50 years	1
pulse in beats per minute	< 100 per minute	0
	>= 100 per minute	1
oxygen saturation	>= 95%%	0
	<= 94%	1
hemoptysis	absent	0
	present	1
unilateral leg swelling	absent	0
	present	1
recent surgery or trauma	absent	0
	present	1
history of PE or DVT	absent	0
	present	1
oral hormone use	absent	0
	present	1

Parameter	Finding	Equation
age in years	<= 50 years	0
	> 50 years	0.5449
pulse in beats per minute	<= 100 per minute	0
	> 100 per minute	0.451
oxygen saturation	>= 95%%	0
	< 95%%	1.2049
cough	absent	0
	present	-0.3768
hemoptysis	absent	0
	present	1.0382
unilateral leg swelling	absent	0
	present	1.0844
recent surgery or trauma	absent	0
	present	0.6651
history of PE or DVT	absent	0
	present	0.6354
oral hormone use	absent	0
	present	0.5166
asthma, COPD, wheezing	absent	0
	present	-0.6072

where:

• Age and heart rate differ in the cut-offs between the 2 equations.

• Cough and asthma/COPD/wheezing are in the logistic regression model but not the rule.

rule score =

= SUM(points for all 8 parameters)

X for logistic regression model =

= SUM(points for all 10 parameters) –3.1246

probability of PE =

= 1 / (1 + EXP((-1) * X))

Interpretation:

• minimum score for rule score: 0

• maximum score for rule score: 8

• A rule score of 0 indicates a patient in the ED at low risk for pulmonary embolism and may not need additional diagnostic testing.

Performance:

• The performance has varied in different study. One source of variation is use in a population NOT considered low risk by the clinician.

To read more or access our algorithms and calculators, please log in or register.

Description

Specialty

Objective

ICD-10

PERC Rule - Pulmonary Embolism Rule-Out Criteria (Charlotte Criteria)

Purpose: To evaluate a patient in the Emergency Department (ED) with suspected pulmonary embolism (PE) using the PERC rule of Kline et al.

Description

Specialty

Objective

ICD-10