MDCalc

PERC Rule for Pulmonary Embolism

Rules out PE if no criteria are present and pre-test probability is ≤15%.

Age ≥50
HR ≥100
O₂ sat on room air <95%
Unilateral leg swelling
Hemoptysis
Recent surgery or trauma
Surgery or trauma ≤4 weeks ago requiring treatment with general anesthesia
Prior PE or DVT
Hormone use
Oral contraceptives, hormone replacement or estrogenic hormones use in males or female patients

Result:

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Management
  • In the setting of a low-risk patient who is not PERC negative, the physician should consider a d-dimer for further evaluation.
  • If the d-dimer is negative, and clinical gestalt determines a pre-test probability is <15% then, the patient does not require further testing for PE.
  • If the d-dimer is positive, further testing such as a CT-angiography or V/Q scan should be pursued.
Critical Actions
  • There is no need to apply the PERC rule to those patients who are not being evaluated for PE.
  • If the patient is considered low-risk, PERC may help avoid further testing.
  • If the patient is moderate or high risk then PERC can not be utilized. Consider d-dimer or imaging based on risk.
  • Consider pericardial disease in patients with pleuritic complaints as well.
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