Summary

Pulmonary embolism rule-out decision-making tools for patients aged 35 years or younger in hospital emergency departments: a post-hoc analysis of performance in 3 prospective cohorts

Dorian Teissandier1, Anne-Laure Philippon1,2, Héloise Bannelier2, Pierre-Marie Roy3, Andrea Penaloza4, Sònia Jiménez5, Yonathan Freund1,2, Melanie Roussel6, Pierre Catoire1,2

Affiliation of the authors

1Emergency Department, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France. 2FHU IMPEC Improving Emergency Care, UMR 1166, IHU ICAN, Sorbonne Université, Paris, France. 3Emergency Department, Centre Hospitalier Universitaire Angers, Institut Mitovasc, Université d’Angers, Angers, France. 4Emergency Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium. 5Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, University of Barcelona, Catalonia, Spain. 6Emergency Department, Centre Hospitalier Universitaire de Rouen, Université de Normandie UNIROUEN, Rouen, France.

DOI

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Quote

Teissandier D, Philippon AL, Bannelier H, Roy PM, Penaloza A, Jiménez S, et al. Pulmonary embolism rule-out decision-making tools for patients aged 35 years or younger in hospital emergency departments: a post-hoc analysis of performance in 3 prospective cohorts. Emergencias. 2023;35:432-6

Summary

Objectives.

To assess the performance of the Pulmonary Embolism Rule-out Criteria (PERC) and the age-modified PERC-35 tool in hospital emergency departments (EDs) for evaluating patients aged 35 years or younger. A secondary aim was to assess other decision-making criteria.

Method.

Post-hoc analysis of 3 European cohort studies. We included data for patients aged 35 years or younger suspected of PE who were followed for 3 months. The safety and efficacy of applying the PERC and PERC-35 were assessed with the diagnostic error rate (failure to detect PE) and the proportion of patients in whom a diagnosis of PE was ruled out. We also assessed the safety and efficacy of applying the YEARS and PEGeD criteria.

Results.

Data for 1235 patients aged 35 years or younger were analyzed. Twenty-two (1.8%; 95% CI, 1.2%-2.7%) PE cases were diagnosed at 3 months. Six (1.0%; 95% CI, 0.5%-2.2%) and 5 (0.9%; 95% CI, 0.4%-2.1%) PE cases were not diagnosed by the PERC and PERC-35 tools, respectively. These tools allowed PE to be ruled out in 591 (48.2%; 95% CI, 45.4%-51.0%) and 554 (46.2%; 95% CI, 43.4%-49.0%) cases, respectively. The error rates of the YEARS and PEGeD criteria, respectively, were 0.4% (95% CI, 0.1%-1.1%) and 0.5% (95% CI, 0.2%-1.2%); their efficacy was similar.

Conclusions.

The safety and efficacy profiles of the PERC and PERC-35 algorithms were similar in patients aged 35 years or younger. However, the large confidence intervals we report do not allow us to confirm the safety of using the tools in patients in this age group.

 

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