PERC rule for kids

September 22, 2016

Short Attention Span Summary

How does the PERC rule perform in kids?
This was a retrospective look at how the Wells score and PERC rule performed in kids.  The prevalence of disease in these 561 patients (<22 years old) being evaluated for PE by D-dimer or CTPA or V/Q was 6.4%.  “The Wells criteria demonstrated a sensitivity and specificity of 86% and 60%, respectively. The sensitivity and specificity of the PERC were 100% and 24%, respectively.”  Bear in mind, Wells was never meant to rule out PE; rather, it was meant to assess pre-test probability of disease.  So I’m not sure what to do with this information.

Spoon Feed
PERC was designed to rule out disease, like a diagnostic test.  It performed well in kids with suspicion of PE.  Though before I would feel comfortable recommending it in kids, it would be good to see a larger, prospective evaluation.  This is a helpful review article on PE workup in kids.

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Abstract

J Pediatr. 2016 Aug 24. pii: S0022-3476(16)30648-5. doi: 10.1016/j.jpeds.2016.07.046. [Epub ahead of print]

Detection of Pulmonary Embolism in High-Risk Children.

Hennelly KE1, Baskin MN2, Monuteuax MC2, Hudgins J2, Kua E2, Commeree A2, Kimia R2, Lee EY3, Kimia A2, Neuman MI2.

Author information:

1Division of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, MO. Electronic address: Hennelly_K@kids.wustl.edu.

2Divisions of Emergency Medicine, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.

3Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA.

Abstract

OBJECTIVE:

To evaluate 2 commonly used adult-based pulmonary embolism (PE) algorithms in pediatric patients and to derive a pediatric-specific clinical decision rule to evaluate children at risk for PE, given the paucity of data to guide diagnostic imaging in children for whom PE is suspected.

STUDY DESIGN:

We performed a single-center retrospective study among 561 children <22 years of age undergoing either D-dimer testing or radiologic evaluation (computed tomography or ventilation-perfusion scan) in the emergency department setting for concern of PE. A diagnosis of PE required radiologic confirmation and anticoagulant treatment. We evaluated the test characteristics of the Wells criteria and Pulmonary Embolism Rule-out Criteria (PERC) low-risk rule and used recursive partition analysis to derive a clinical decision rule.

RESULTS:

Among the 561 patients included in the study, 36 (6.4%) were diagnosed with PE. The Wells criteria demonstrated a sensitivity and specificity of 86% and 60%, respectively. The sensitivity and specificity of the PERC were 100% and 24%, respectively. A clinical decision rule including the presence of oral contraceptive use, tachycardia, and oxygen saturation <95% demonstrated a sensitivity and specificity of 90% and 56%, respectively, a positive and negative likelihood ratio of 2.0 and 0.2, and a positive and negative predictive value of 0.12 and 0.99, respectively.

CONCLUSIONS:

The risk of PE is low among children not receiving estrogen therapy and without tachycardia and hypoxia in those with an initial suspicion of PE. Application of the PERC rule and Wells criteria should be used cautiously in the pediatric population.

Copyright © 2016 Elsevier Inc. All rights reserved.

PMID: 27567411 [PubMed – as supplied by publisher]