Tuesday, February 20, 2018


R.E.B.E.L.EM - February 19, 2018
"Background: The diagnosis of PE is a tricky thing. We want to limit over-testing patients and therefore, over-diagnosis. On the other hand, we don’t want to limit testing so much that we miss the diagnosis where treatment would make a difference. The pulmonary embolism rule-out criteria (PERC) was created to reduce testing in patients who have a low probability of PE (i.e. prevalence of <1.8%) in which further testing would not be necessary. There have been many observational trials published on this score but until now there has not been a prospective randomized clinical trial (The PROPER Trial)...
Author Conclusion: “Among very low-risk patients with suspected PE, randomization to a PERC strategy vs conventional strategy did not result in an inferior rate of thromboembolic events over 3 months. These findings support the safety of PERC for very low-risk patients presenting to the emergency department.”
Clinical Take Home Point: In a “low risk” patient population, use of PERC over usual care, was non-inferior in both diagnosis and mortality associated with PE. An added benefit of using PERC over usual care in this study was a 10% decrease in imaging and 40min decrease in ED LOS."