Skip to main content
padlock icon - secure page this page is secure

Free Content Prospective multicenter evaluation of the pulmonary embolism rule‐out criteria

Download Article:

You have access to the full text article on a website external to Ingenta Connect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library

Summary.  Backgound: Over‐investigation of low‐risk patients with suspected pulmonary embolism (PE) represents a growing problem. The combination of gestalt estimate of low suspicion for PE, together with the PE rule‐out criteria [PERC(−): age < 50 years, pulse < 100 beats min−1, SaO2 ≥ 95%, no hemoptysis, no estrogen use, no surgery/trauma requiring hospitalization within 4 weeks, no prior venous thromboembolism (VTE), and no unilateral leg swelling], may reduce speculative testing for PE. We hypothesized that low suspicion and PERC(−) would predict a post‐test probability of VTE(+) or death below 2.0%. Methods: We enrolled outpatients with suspected PE in 13 emergency departments. Clinicians completed a 72‐field, web‐based data form at the time of test order. Low suspicion required a gestalt pretest probability estimate of <15%. The main outcome was the composite of image‐proven VTE(+) or death from any cause within 45 days. Results: We enrolled 8138 patients, 85% of whom had a chief complaint of either dyspnea or chest pain. Clinicians reported a low suspicion for PE, together with PERC(−), in 1666 patients (20%). At initial testing and within 45 days, 561 patients (6.9%, 95% confidence interval 6.5–7.6) were VTE(+), and 56 others died. Among the low suspicion and PERC(−) patients, 15 were VTE(+) and one other patient died, yielding a false‐negative rate of 16/1666 (1.0%, 0.6–1.6%). As a diagnostic test, low suspicion and PERC(−) had a sensitivity of 97.4% (95.8–98.5%) and a specificity of 21.9% (21.0–22.9%). Conclusions: The combination of gestalt estimate of low suspicion for PE and PERC(−) reduces the probability of VTE to below 2% in about 20% of outpatients with suspected PE.
No References
No Citations
No Supplementary Data
No Article Media
No Metrics

Keywords: D‐dimer; computerized tomography angiography; decision rule; decision‐making; diagnosis; medical malpractice; pulmonary embolism; venous thromboembolism

Document Type: Research Article

Affiliations: 1: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 2: Department of Emergency Medicine, Northwestern Memorial Hospital, Chicago, IL 3: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 4: Department of Surgery, Yale University School of Medicine, New Haven, CT 5: Department of Emergency Medicine, Baystate Medical Center, Springfield, MA 6: Department of Emergency Medicine, St. Vincent Mercy Medical, Toledo, OH 7: Department of Emergency Medicine, Mayo Clinic, Scottsdale, AZ 8: Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI 9: Department of Surgery, University of Colorado School of Health Sciences, Denver, CO, USA

Publication date: May 1, 2008

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more