• Judith Gorlicki, Andrea Penaloza, Boris Germeau, Thomas Moumneh, Anne-Laure Philippon, Jennifer Truchot, Delphine Douillet, Charlotte Steinier, Caroline Soulié, Ben Bloom, Marine Cachanado, Pierre-Marie Roy, and Yonathan Freund.
• Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France.
• Acad Emerg Med. 2019 Jan 1; 26 (1): 23-30.

BackgroundThis study aimed to determine the failure rate of a combination of the PERC and the YEARS rules for the diagnosis of pulmonary embolism (PE) in the emergency department (ED).MethodsWe performed a retrospective analysis of two European cohorts of emergency patients with low gestalt clinical probability of PE (PROPER and PERCEPIC). All patients we included were managed using a conventional strategy (D-dimer test, followed, if positive, by computed tomographic pulmonary angiogram (CTPA). We tested a diagnostic strategy that combined PERC and YEARS to rule out PE. The primary endpoint was a thromboembolic event diagnosed in the ED or at 3-months follow-up. Secondary endpoints included a thromboembolic event at baseline in the ED and a CTPA in the ED. Ninety-five percent confidence intervals (CIs) of proportions were calculated with the use of Wilson's continuity correction.ResultsWe analyzed 1,951 patients (mean ± SD age = 47 ± 18 years, 56% women) with an overall proportion of patients with PE of 3.5%. Both PERC and YEARS strategies were associated with 11 missed PE in the ED: failure rate 0.57 (95% CI = 0.32-1.02). At 3-month follow-up, the overall failure rate was 0.83% (95% CI = 0.51-1.35). Among the 503 patients who underwent a CTPA (26%), the use of the PERC-YEARS combination would have ruled out PE without CTPA in 249 patients (50% [95%CI = 45%-54%], absolute reduction 13% (95% CI = 11%-14%]).ConclusionThe combination of PERC then YEARS was associated with a low risk of PE diagnostic failure and would have resulted in a relative reduction of almost half of CTPA.© 2018 by the Society for Academic Emergency Medicine.

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