This is Steve Carroll, and you're listening to EM Basic Essential Evidence.

Today, we're going to be discussing the paper that created and then validated the pulmonary

embolism rule out criteria, or PERC. This is a clinical decision aid that we can use in the ED

to safely exclude patients with pulmonary embolism, or PE.

The PER rule is based on clinical criteria alone and helps us avoid using a D-dimer in the

workup for PE.

We'll talk a little bit about how you use this in real life and the pearls and pitfalls associated

with the rules as well.

This is not a deep dive on PE by any means, but we'll go through the

PIRP paper and then talk about how to use it in your everyday practice. As always, this podcast

is a representative views or opinions of the Department of Defense, the U.S. Army, or the Ford

Hood Post Command. So let's get started. The title of this paper is, clinical criteria to

prevent unnecessary diagnostic testing in emergency department patients with suspect The title of this paper is, Clinical Criteria to Prevent Unnecessary

Testing in Emergency Department Patients with suspected pulmonary embolism.

It was published in the Journal of Thrombosis and Hemosasis in 2004, and the first author

is Dr. Jeffrey Klein.

The full text is available for free online, so I'll post it on EMBASA.org and link to it on the website.

First, let's give a little background on the problem.

Pulmonary embolism is a diagnosis that we consider a lot in the emergency department.

We see a lot of patients with chest pain and or shortness of breath in whom we consider the diagnosis.

We constantly worry about missing this

diagnosis and being the one that sends home to a patient who comes back with a bad outcome.

...