How do you use wells and PERC criteria?
Use either the Wells or Geneva rules to choose tests based on a patient’s risk for pulmonary embolism. If the patient is at low risk, clinicians should use the eight PERC; if a patient does not meet all eight criteria, the risks of testing are greater than the risk for embolism, and no testing is needed.
What is PERC criteria?
The Pulmonary Embolism Rule-out Criteria (PERC) is an eight-item block of clinical criteria that can identify patients who can safely be discharged from the ED without further investigation for PE.
What is the PERC rule for PE?
The PERC rule is used to rule out pulmonary embolism in those patients where the clinical gestalt is that they are low risk (ie <15% risk of pulmonary embolism). Pulmonary embolism can be ruled out if none of the following features are identified: Age ≥50 years. Heart rate ≥100 bpm.
What is PERC positive?
Pulmonary embolism workup can be ruled out if (1) none of the above eight variables is positive and (2) there is a less than 15% (very low) pretest probability that the patient has a pulmonary embolism. A PERC evaluation is considered positive if any one of the eight criteria are met.
What is Wells rule?
The Wells criteria for pulmonary embolism is a risk stratification score and clinical decision rule to estimate the probability for acute pulmonary embolism (PE) in patients in which history and examination suggests acute PE is a diagnostic possibility.
What are the Wells criteria?
What is the Wells criteria for DVT?
Table 1 Wells criteria for the prediction of deep vein thrombosis (DVT) a
| Clinical Characteristic | Score |
|---|---|
| Localized tenderness along the distribution of the deep venous system | 1 |
| Entire leg swelling | 1 |
| Calf swelling at least 3 cm larger than that on the asymptomatic side (measured 10 cm below tibial tuberosity) | 1 |
How do you remember Wells score in PE?
The components of the modified Wells criteria for PE can be remembered with the mnemonic: “ EAT CHIPS”. “E” is for edema in the leg or any other symptoms of DVT, and this is given 3 points. “A” is for alternative diagnosis being less likely, and this also gets 3 points.
What is two level PE Wells score?
Table 2 Two-level PE Wells score
| Clinical feature | Points |
|---|---|
| Malignancy (on treatment, treated in the last 6 months, or palliative) | 1 |
| Clinical probability simplified score | Points |
| PE likely | More than 4 points |
| PE unlikely | 4 points or less |
What is PERC negative?
The PERC Rule is a “rule-out” tool – all variables must receive a “no” to be negative. The test is unidirectional: while PERC negative typically allows the clinician to avoid further testing, failing the rule doesn’t force the clinician to order tests. As a rule-out criteria, PERC is not meant for risk-stratification.
Can you use PERC rule in pregnancy?
The PERC rule should not be used in isolation to rule out PE in pregnant or postpartum patients. The PERC rule includes hypoxemia or tachycardia at any point during the evaluation.
What is the PERC criteria for pulmonary embolism?
PERC = Pulmonary Embolism Rule-out Criteria. Pulmonary embolism can be ruled out clinically if none of the 8 PERC criteria are present in a patient with a low pretest probability of PE (e.g. Wells PE CPG score of <3) that is consistent with the ‘gestalt’ of an experienced physician: age < 50 years. pulse < 100 beats min.
Rules out PE if no criteria are present and pre-test probability is ≤15%. The PERC rule can be applied to patients where the diagnosis of PE is being considered, but the patient is deemed low-risk.
Can the PERC be used to apply to low risk patients?
Note that when using the Wells criteria for PE, low risk (score 0 or 1) is a probability of 1.3% and moderate risk (score 2 to 6) is a probability of 16.2%. Thus the PERC can be safely applied to low risk patients, but not moderate risk patients when using the Well’s criteria for PE.
What is Wells’ criteria?
The Wells’ Criteria risk stratifies patients for pulmonary embolism (PE) and provides an estimated pre-test probability. The physician can then chose what further testing is required for diagnosing pulmonary embolism (I.E. d-dimer or CT angiogram).