Carpenter Christopher R, Keim Samuel M, Seupaul Rawle A, Pines Jesse M
Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
J Emerg Med. 2009 Apr;36(3):317-22. doi: 10.1016/j.jemermed.2008.06.017. Epub 2008 Dec 20.
Pulmonary embolism (PE) remains one of the most challenging diagnoses in emergency medicine. The Pulmonary Embolism Rule-out Criteria (PERC) score, a decision aid to reliably distinguish low-risk from very low-risk PE patients, has been derived and validated.
Can a subset of patients with sufficiently low risk for PE be identified who require no diagnostic testing?
The PERC score derivation and validation trials were located using PubMed and Web of Science. A critical appraisal of this research is presented.
One single-center and another multi-center validation trial both confirmed that the eight-item PERC score identified a very low-risk subset of patients in whom PE was clinically contemplated with a negative likelihood ratio 0.17 (95% confidence interval 0.11-0.25) in the larger trial. If applied, the rule would have identified 20% of potential PE patients as very low risk.
The PERC score provides clinicians with an easily remembered, validated clinical decision rule that allows physicians to forego diagnostic testing for pulmonary embolus in a very low-risk population.
肺栓塞（PE）仍然是急诊医学中最具挑战性的诊断之一。肺栓塞排除标准（PERC）评分作为一种可靠区分低风险和极低风险PE患者的决策辅助工具，已经得到推导和验证。
能否识别出一组PE风险足够低且无需进行诊断性检查的患者？
使用PubMed和科学网查找PERC评分的推导和验证试验。对该研究进行了批判性评价。
一项单中心和另一项多中心验证试验均证实，八项PERC评分识别出了一个极低风险的患者亚组，在较大规模的试验中，该亚组临床考虑PE的阴性似然比为0.17（95%置信区间0.11 - 0.25）。如果应用该规则，将有20%的潜在PE患者被识别为极低风险。
PERC评分为临床医生提供了一个易于记忆且经过验证的临床决策规则，使医生能够在极低风险人群中放弃对肺栓塞的诊断性检查。
