Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA.
Acad Emerg Med. 2010 Sep;17(9):1016-9. doi: 10.1111/j.1553-2712.2010.00826.x.
The pulmonary embolism rule-out criteria (PERC rule) is a nine-component decision rule derived to exclude pulmonary embolism (PE) without the use of formal diagnostic testing (D-dimer, computed tomography pulmonary angiography, ventilation-perfusion lung scanning, or venous ultrasonography) when all nine components are negative ("PERC negative"). This study examined whether clinicians who document PERC negative also document results of all nine components of the PERC rule.
This was a pilot study at a single-center, urban teaching emergency department (ED) with a residency program in emergency medicine. Patients were over 17 years of age with at least one of nine predefined chief complaints. Clinicians were asked three questions regarding suspicion for PE, intent to use the PERC rule, and the result. Charts were independently reviewed by two authors for fidelity of the nine PERC components. Patients were followed for PE outcome at 14 days.
The study examined 526 patients cared for by 82 clinicians, who indicated suspicion for PE in 183 of 526 (35%) and intent to use the PERC rule in 115 of 526 (22%) cases, of whom 65 of 115 were documented as PERC negative. No formal test for PE was ordered in 49 of 65 (75%), and 46 of 49 had incomplete documentation to support PERC negative. The most common deficiency was omission of two risk factors for PE in the rule (prior venous thromboembolism or recent surgery). Six patients had PE diagnosed within 14 days, but none of these had been deemed PERC negative.
Clinicians seldom document all nine data elements of the PERC rule in patients they deem PERC negative. These data suggest the need for paper or electronic aids to support use of the PERC rule.
排除肺栓塞规则（PERC 规则）是一个由九个组成部分的决策规则，旨在在不使用正式诊断测试（D-二聚体、计算机断层扫描肺动脉造影、通气-灌注肺扫描或静脉超声）的情况下排除肺栓塞（PE），当所有九个组成部分均为阴性时（“PERC 阴性”）。本研究检验了在记录 PERC 阴性的临床医生是否也记录了 PERC 规则的所有九个组成部分的结果。
这是一项单中心、城市教学急诊部（ED）的试点研究，该 ED 设有急诊医学住院医师项目。患者年龄在 17 岁以上，有九个预定义的主要主诉之一。临床医生被问到三个关于 PE 怀疑、使用 PERC 规则的意图和结果的问题。由两位作者独立审查图表，以确定 PERC 九个组成部分的真实性。对患者进行为期 14 天的 PE 结局随访。
该研究共检查了 526 名由 82 名临床医生治疗的患者，其中 183 名（35%）患者怀疑有 PE，115 名（22%）患者有使用 PERC 规则的意图，其中 65 名（65%）患者被记录为 PERC 阴性。在 49 名（75%）患者中未开出任何 PE 正式检查，其中 46 名（46%）患者的记录不足以支持 PERC 阴性。最常见的缺陷是遗漏了规则中两个 PE 风险因素（既往静脉血栓栓塞或近期手术）。在 14 天内诊断出 6 名患者患有 PE，但没有一名被认为是 PERC 阴性。
临床医生很少在他们认为 PERC 阴性的患者中记录 PERC 规则的所有九个数据元素。这些数据表明需要纸质或电子辅助工具来支持 PERC 规则的使用。
