Evaluation of the pulmonary embolism rule-out criteria in a retrospective cohort at an urban academic hospital
Abstract Background The pulmonary embolism rule-out criteria (PERC) is an 8-variable clinical decision rule that identifies patients at low risk for pulmonary embolism (PE) to prevent unnecessary diagnostic testing in the evaluation of suspected PE in the emergency department (ED). The objective of...
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description | Abstract Background The pulmonary embolism rule-out criteria (PERC) is an 8-variable clinical decision rule that identifies patients at low risk for pulmonary embolism (PE) to prevent unnecessary diagnostic testing in the evaluation of suspected PE in the emergency department (ED). The objective of this study was to determine PERC's safety and diagnostic use in our institution's ED population. Methods We performed a retrospective analysis on consecutive adult patients evaluated with computed tomographic angiography (CTA) for suspicion of PE at our ED during the dates January 1, 2011, to December 31, 2011. Patients negative for all 8 PERC criteria (ie, “PERC [−]”) were considered to be at low risk for PE. All data were analyzed using SPSS-20 (SPSS Inc, Chicago, IL) to calculate the variables of interest and their respective 95% confidence intervals (95% CIs). Results During the 12-month study period, 729 subjects were evaluated with CTA for suspicion of PE. Ten subjects were excluded because of nondiagnostic imaging studies. After exclusion, 719 subjects were available for analysis. Prevalence of PE was 4.5%. PERC (−) had a sensitivity of 96.9% (95% CI, 84.3%-99.4%), a negative predictive value of 98.8% (95% CI, 93.5%-99.8%), and a negative likelihood ratio of 0.26 (95% CI, 0.04-1.82) when used as an independent diagnostic test to exclude PE. Conclusions Use of PERC could have safely avoided 11.5% of CTAs, reducing potential patient harm, health care costs, and unnecessary diagnostic testing. Consistent with prior studies, PERC can be safely used to identify low-risk patients for whom further testing can be deferred. |
doi_str_mv | 10.1016/j.ajem.2013.10.010 |
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The objective of this study was to determine PERC's safety and diagnostic use in our institution's ED population. Methods We performed a retrospective analysis on consecutive adult patients evaluated with computed tomographic angiography (CTA) for suspicion of PE at our ED during the dates January 1, 2011, to December 31, 2011. Patients negative for all 8 PERC criteria (ie, “PERC [−]”) were considered to be at low risk for PE. All data were analyzed using SPSS-20 (SPSS Inc, Chicago, IL) to calculate the variables of interest and their respective 95% confidence intervals (95% CIs). Results During the 12-month study period, 729 subjects were evaluated with CTA for suspicion of PE. Ten subjects were excluded because of nondiagnostic imaging studies. After exclusion, 719 subjects were available for analysis. Prevalence of PE was 4.5%. PERC (−) had a sensitivity of 96.9% (95% CI, 84.3%-99.4%), a negative predictive value of 98.8% (95% CI, 93.5%-99.8%), and a negative likelihood ratio of 0.26 (95% CI, 0.04-1.82) when used as an independent diagnostic test to exclude PE. Conclusions Use of PERC could have safely avoided 11.5% of CTAs, reducing potential patient harm, health care costs, and unnecessary diagnostic testing. Consistent with prior studies, PERC can be safely used to identify low-risk patients for whom further testing can be deferred.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2013.10.010</identifier><identifier>PMID: 25745794</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Academic Medical Centers - statistics & numerical data ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Computed tomography ; Confidence intervals ; Decision Support Techniques ; Diagnosis, Differential ; Dissection ; Embolisms ; Emergency ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital - statistics & numerical data ; Female ; Hospitals ; Hospitals, Urban - statistics & numerical data ; Humans ; Male ; Medical imaging ; Medical records ; Meta-analysis ; Middle Aged ; Mortality ; Predictive Value of Tests ; Pulmonary Embolism - diagnosis ; Retrospective Studies ; Risk Assessment ; Sensitivity and Specificity ; Studies ; Tomography, X-Ray Computed</subject><ispartof>The American journal of emergency medicine, 2015-04, Vol.33 (4), p.483-487</ispartof><rights>Elsevier Inc.</rights><rights>2013 Elsevier Inc.</rights><rights>2013 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c509t-ecdd2390a63ab4a886177a36ae59363004aa40068ada26d4b3ab7619bb71b4d53</citedby><cites>FETCH-LOGICAL-c509t-ecdd2390a63ab4a886177a36ae59363004aa40068ada26d4b3ab7619bb71b4d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1674232690?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25745794$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bozarth, Andrew L., MD</creatorcontrib><creatorcontrib>Bajaj, Navin, MD</creatorcontrib><creatorcontrib>Wessling, Margaret R., MD</creatorcontrib><creatorcontrib>Keffer, Dustin, DO</creatorcontrib><creatorcontrib>Jallu, Shais, MD</creatorcontrib><creatorcontrib>Salzman, Gary A., MD, FCCP, FACP</creatorcontrib><title>Evaluation of the pulmonary embolism rule-out criteria in a retrospective cohort at an urban academic hospital</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Abstract Background The pulmonary embolism rule-out criteria (PERC) is an 8-variable clinical decision rule that identifies patients at low risk for pulmonary embolism (PE) to prevent unnecessary diagnostic testing in the evaluation of suspected PE in the emergency department (ED). The objective of this study was to determine PERC's safety and diagnostic use in our institution's ED population. Methods We performed a retrospective analysis on consecutive adult patients evaluated with computed tomographic angiography (CTA) for suspicion of PE at our ED during the dates January 1, 2011, to December 31, 2011. Patients negative for all 8 PERC criteria (ie, “PERC [−]”) were considered to be at low risk for PE. All data were analyzed using SPSS-20 (SPSS Inc, Chicago, IL) to calculate the variables of interest and their respective 95% confidence intervals (95% CIs). Results During the 12-month study period, 729 subjects were evaluated with CTA for suspicion of PE. Ten subjects were excluded because of nondiagnostic imaging studies. After exclusion, 719 subjects were available for analysis. Prevalence of PE was 4.5%. PERC (−) had a sensitivity of 96.9% (95% CI, 84.3%-99.4%), a negative predictive value of 98.8% (95% CI, 93.5%-99.8%), and a negative likelihood ratio of 0.26 (95% CI, 0.04-1.82) when used as an independent diagnostic test to exclude PE. Conclusions Use of PERC could have safely avoided 11.5% of CTAs, reducing potential patient harm, health care costs, and unnecessary diagnostic testing. Consistent with prior studies, PERC can be safely used to identify low-risk patients for whom further testing can be deferred.</description><subject>Academic Medical Centers - statistics & numerical data</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Computed tomography</subject><subject>Confidence intervals</subject><subject>Decision Support Techniques</subject><subject>Diagnosis, Differential</subject><subject>Dissection</subject><subject>Embolisms</subject><subject>Emergency</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Hospitals</subject><subject>Hospitals, Urban - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical records</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Predictive Value of Tests</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Sensitivity and Specificity</subject><subject>Studies</subject><subject>Tomography, X-Ray Computed</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kk-LFDEQxYMo7rj6BTxIwIuXHvOvk2kQQZbVFRY8qOdQna5h0qY7Y5Ie2G9vmlld2IMQEih-r0i9V4S85mzLGdfvxy2MOG0F47IWtoyzJ2TDWymaHTf8KdkwI9tGm9ZckBc5j4xxrlr1nFyI1qjWdGpD5usThAWKjzONe1oOSI9LmOIM6Y7i1Mfg80TTErCJS6Eu-YLJA_UzBZqwpJiP6Io_IXXxEFOhUM9Ml9TXGxwMOHlHDxXzBcJL8mwPIeOr-_eS_Px8_ePqprn99uXr1afbxrWsKw26YRCyY6Al9Ap2O82NAakB205qyZgCUIzpHQwg9KD6ihnNu743vFdDKy_Ju3PfY4q_F8zFTj47DAFmjEu2vLqyM0LorqJvH6FjXNJcf7dSSsgKsUqJM-XqxDnh3h6Tn6pJljO7pmFHu6Zh1zTWWk2jit7ct176CYd_kr_2V-DDGcDqxcljstl5nB0OPlVX7RD9__t_fCR3wc_eQfiFd5gf5rBZWGa_r_uwrgOXq3d1U_4AYIqwZw</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Bozarth, Andrew L., MD</creator><creator>Bajaj, Navin, MD</creator><creator>Wessling, Margaret R., MD</creator><creator>Keffer, Dustin, DO</creator><creator>Jallu, Shais, MD</creator><creator>Salzman, Gary A., MD, FCCP, FACP</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Evaluation of the pulmonary embolism rule-out criteria in a retrospective cohort at an urban academic hospital</title><author>Bozarth, Andrew L., MD ; Bajaj, Navin, MD ; Wessling, Margaret R., MD ; Keffer, Dustin, DO ; Jallu, Shais, MD ; Salzman, Gary A., MD, FCCP, FACP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c509t-ecdd2390a63ab4a886177a36ae59363004aa40068ada26d4b3ab7619bb71b4d53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Academic Medical Centers - statistics & numerical data</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Computed tomography</topic><topic>Confidence intervals</topic><topic>Decision Support Techniques</topic><topic>Diagnosis, Differential</topic><topic>Dissection</topic><topic>Embolisms</topic><topic>Emergency</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Hospitals</topic><topic>Hospitals, Urban - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical records</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Predictive Value of Tests</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Sensitivity and Specificity</topic><topic>Studies</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bozarth, Andrew L., MD</creatorcontrib><creatorcontrib>Bajaj, Navin, MD</creatorcontrib><creatorcontrib>Wessling, Margaret R., MD</creatorcontrib><creatorcontrib>Keffer, Dustin, DO</creatorcontrib><creatorcontrib>Jallu, Shais, MD</creatorcontrib><creatorcontrib>Salzman, Gary A., MD, FCCP, FACP</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database (ProQuest)</collection><collection>Immunology Abstracts</collection><collection>Proquest Health and Medical Complete</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bozarth, Andrew L., MD</au><au>Bajaj, Navin, MD</au><au>Wessling, Margaret R., MD</au><au>Keffer, Dustin, DO</au><au>Jallu, Shais, MD</au><au>Salzman, Gary A., MD, FCCP, FACP</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of the pulmonary embolism rule-out criteria in a retrospective cohort at an urban academic hospital</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>33</volume><issue>4</issue><spage>483</spage><epage>487</epage><pages>483-487</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>Abstract Background The pulmonary embolism rule-out criteria (PERC) is an 8-variable clinical decision rule that identifies patients at low risk for pulmonary embolism (PE) to prevent unnecessary diagnostic testing in the evaluation of suspected PE in the emergency department (ED). The objective of this study was to determine PERC's safety and diagnostic use in our institution's ED population. Methods We performed a retrospective analysis on consecutive adult patients evaluated with computed tomographic angiography (CTA) for suspicion of PE at our ED during the dates January 1, 2011, to December 31, 2011. Patients negative for all 8 PERC criteria (ie, “PERC [−]”) were considered to be at low risk for PE. All data were analyzed using SPSS-20 (SPSS Inc, Chicago, IL) to calculate the variables of interest and their respective 95% confidence intervals (95% CIs). Results During the 12-month study period, 729 subjects were evaluated with CTA for suspicion of PE. Ten subjects were excluded because of nondiagnostic imaging studies. After exclusion, 719 subjects were available for analysis. Prevalence of PE was 4.5%. PERC (−) had a sensitivity of 96.9% (95% CI, 84.3%-99.4%), a negative predictive value of 98.8% (95% CI, 93.5%-99.8%), and a negative likelihood ratio of 0.26 (95% CI, 0.04-1.82) when used as an independent diagnostic test to exclude PE. Conclusions Use of PERC could have safely avoided 11.5% of CTAs, reducing potential patient harm, health care costs, and unnecessary diagnostic testing. Consistent with prior studies, PERC can be safely used to identify low-risk patients for whom further testing can be deferred.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25745794</pmid><doi>10.1016/j.ajem.2013.10.010</doi><tpages>5</tpages></addata></record> |
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subjects | Academic Medical Centers - statistics & numerical data Adolescent Adult Aged Aged, 80 and over Computed tomography Confidence intervals Decision Support Techniques Diagnosis, Differential Dissection Embolisms Emergency Emergency medical care Emergency medical services Emergency Service, Hospital - statistics & numerical data Female Hospitals Hospitals, Urban - statistics & numerical data Humans Male Medical imaging Medical records Meta-analysis Middle Aged Mortality Predictive Value of Tests Pulmonary Embolism - diagnosis Retrospective Studies Risk Assessment Sensitivity and Specificity Studies Tomography, X-Ray Computed |
title | Evaluation of the pulmonary embolism rule-out criteria in a retrospective cohort at an urban academic hospital |
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