PERC Rule for Pulmonary Embolism
Can PE be excluded without D-dimer testing in a low-risk patient?
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About this tool
Eight criteria that, when all absent in a patient with low clinical gestalt, rule out PE without further testing.
Intended use
ED patients in whom the clinician's gestalt pretest probability of PE is < 15%.
Outcome
Exclusion of PE
Time horizon
Current episode (45-day follow-up in studies)
Derivation population
US emergency department patients evaluated for PE.
Do not use in
Patients whose pretest probability is not low.
Limitations
- Only valid with low gestalt pretest probability.
- Performance is lower in high-prevalence settings.
Clinical problems
Evidence
Evidence level
Strong evidence
Derived and externally validated in multiple cohorts (including prospective studies) and incorporated into major clinical guidelines. Methodology
Guideline status
Supported by the 2018 ACEP clinical policy on suspected PE; evaluated in the PROPER randomised trial.
Validation studies
Low-gestalt ED patients in France
3-month thromboembolic events 0.1% with the PERC strategy vs 0% with usual care (non-inferior).
References
- Original publicationKline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004;2:1247-1255. Find on PubMed (opens in a new tab)
- Validation studyKline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008;6:772-780. Find on PubMed (opens in a new tab)
- Validation studyFreund Y, Cachanado M, Aubry A, et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA 2018;319:559-566. Find on PubMed (opens in a new tab)
Version history
| Version | Formula | Effective | Reviewer | Changes |
|---|---|---|---|---|
| v1.0.0 | Kline 2004 | 2026-10-03 | — | Initial implementation with reference test vectors. |
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Clinical decision support only. Interpret results in the context of the individual patient and current guidance; HumanPulse does not replace professional medical judgment.