This is part of a recurring series examining landmark articles in Emergency Medicine, in the style of ALiEM’s 52 Articles.
Discussing: “Prospective Multicenter Evaluation of the Pulmonary Embolism Rule-out Criteria.” (J Thromb Haemost 2008; Kline JA et al.)

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Main Points
- Pulmonary Embolism Rule-out Criteria (PERC):
- age < 50,
- heart rate < 100 bpm
- SaO2 < 95%
- no hemoptysis
- no estrogen use
- no surgery/trauma requiring hospitalization within 4 weeks
- no unilateral leg swelling
- no prior venous thromboembolism
2) PERC in combination with clinical gestalt for low suspicion of pulmonary embolism (PE) reduces the probability of venous thromboembolism (VTE) to below 2%.
Background
Chest pain is the most common emergency department chief complaint. The differential diagnosis is vast, and includes high acuity conditions (such as myocardial infarction, aortic aneurysm, and pulmonary embolism) down to low acuity conditions (such as reflux, muscle strain and anxiety.) Pulmonary embolism is one of the high risk clinical conditions that should not be missed. However, determining which patient should or should not be worked up for pulmonary embolism can be difficult. Continue reading