Failure Rate of the Pulmonary Embolism Rule-Out Criteria (PERC-35) in Adults ≤35 Years
Authors: Thibaut Jossein, Lucia Mazzolai, Alicia Lorenzo Hernández, et al.
Journal: Academic Emergency Medicine, 2024
Conclusion
The PERC-35 rule demonstrated a low failure rate for excluding PE in patients aged ≤35 years. It shows potential to safely reduce unnecessary imaging and radiation exposure in young, low-risk patients when applied in clinical practice. Further prospective validation is recommended.
Methods
- Design: Retrospective cohort study.
- Data Source: Registro Informatizado de la Enfermedad TromboEmbolica Venosa (RIETE) Registry, an ongoing international registry of confirmed venous thromboembolism cases.
- Population: 58,918 adults with acute PE, focusing on those ≤35 years.
- Primary Outcome: Missed PE rate using PERC-35 criteria.
- Secondary Outcomes:
- Demographics and clinical characteristics.
- Localization of PE.
- Treatment strategies and outcomes, including bleeding events, recurrence, and mortality.
Results
- Missed PE Rate (Overall):
- PERC-35: 0.35% (n = 204), with an upper 95% CI of 0.40%.
- Missed PE Rate (Age 18-35 Subgroup):
- 7.0% (95% CI 6.0%-7.9%).
- Characteristics of PERC-Negative (PERC-35N) Patients:
- Age: Younger (mean 28.4 years).
- Clinical Profile: Lower BMI, fewer chronic diseases, more chest pain presentations, fewer instances of dyspnea or syncope.
- Lab Findings: Lower rates of positive D-dimer and troponin levels.
- Outcomes in PERC-35N Patients:
- Fewer major bleeding episodes.
- Similar recurrence rates of PE/deep vein thrombosis (DVT).
- No deaths during anticoagulation.
Jossein, T., Mazzolai, L., Lorenzo Hernández, A., Otálora Valderrama, S., Zdraveska, M., Rivas Guerrero, A., López Ruiz, A., Di Micco, P., Monreal, M., Hugli, O. and RIETE Investigators, 2024. Failure rate of the pulmonary embolism rule‐out criteria rule for adults 35 years or younger: Findings from the RIETE Registry. Academic Emergency Medicine.