Pulmonary Embolism Rule-Out Criteria: Diagnostic Accuracy and Impact of COVID-19
Authors: Seda Kilicoglu Tanir, Merve Eksioglu, Tuba Cimilli Ozturk
Journal: Journal of Emergency Medicine, June 2024
Conclusion: The study demonstrates that the sensitivity and negative predictive value of the PERC are comparable between COVID-19 positive and negative patients. PE incidence did not significantly differ between these groups. Although PERC can aid in decision-making, caution should be exercised as it may not always be reliable when used as the sole diagnostic tool, particularly during the COVID-19 pandemic. Further validation is needed to assess PERC’s utility in varying clinical contexts.
Methods: This retrospective study involved patients who presented to the emergency department (ED) and underwent CTPA for suspected PE. COVID-19 status was determined via reverse transcription-polymerase chain reaction (RT-PCR) testing conducted either in the ED or within 30 days prior. The PERC was applied using criteria including age, oxygen saturation, heart rate, and the absence of hemoptysis or trauma. Outcomes were categorized based on concordance between PERC results and CTPA findings, and the impact of COVID-19 status on PERC’s diagnostic performance was analyzed.
Results:
- Sample: A total of 2,430 patients were included, with 45.1% testing negative for COVID-19, 43.4% testing positive, and 11.5% untested.
- PE Detection: PERC identified 91.2% of patients as positive for PE risk, of which only 6.9% were confirmed to have PE via CTPA.
- Discordance: There was an 84.9% discordance rate between PERC results and CTPA findings, indicating low diagnostic concordance.
- COVID-19 Positive Patients:
- Sensitivity: 95.3% (95% CI: 86.91-99.02)
- Specificity: 9.1% (95% CI: 7.46-11.15)
- Positive Predictive Value (PPV): 6.3% (95% CI: 6.01-6.70)
- Negative Predictive Value (NPV): 96.8% (95% CI: 90.81-98.94)
- Accuracy: 14.4% (95% CI: 12.34-16.67)
- COVID-19 Negative Patients:
- Sensitivity: 95.4% (95% CI: 88.64-98.73)
- Specificity: 7.8% (95% CI: 6.25-9.66)
- PPV: 8.1% (95% CI: 7.83-8.57)
- NPV: 95.1% (95% CI: 88.11-98.14)
- Accuracy: 14.7% (95% CI: 12.73-17.02)