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 Teissandier, Anne-Laure Philippon, Héloise Bannelier, Pierre-Marie Roy, Andrea Penaloza, Sònia Jiménez, Yonathan Freund, Melanie Roussel, Pierre Catoire
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Abstract

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.

Material and methods: 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.

Conclusion: 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.

医院急诊科 35 岁及以下患者肺栓塞排除决策工具:对 3 个前瞻性队列的性能进行事后分析。
目的评估肺栓塞排除标准(PERC)和经年龄修正的 PERC-35 工具在医院急诊科(ED)评估 35 岁或以下患者时的性能。另一个目的是评估其他决策标准:对 3 项欧洲队列研究进行事后分析。我们纳入了随访 3 个月的 35 岁及以下疑似 PE 患者的数据。通过诊断错误率(未能检测出 PE)和排除 PE 诊断的患者比例评估了应用 PERC 和 PERC-35 的安全性和有效性。我们还评估了应用 YEARS 和 PEGeD 标准的安全性和有效性:分析了 1235 名 35 岁或以下患者的数据。有 22 例(1.8%;95% CI,1.2%-2.7%)PE 患者在 3 个月后确诊。PERC和PERC-35工具分别有6例(1.0%;95% CI,0.5%-2.2%)和5例(0.9%;95% CI,0.4%-2.1%)PE病例未被确诊。通过这些工具,分别有 591 例(48.2%;95% CI,45.4%-51.0%)和 554 例(46.2%;95% CI,43.4%-49.0%)病例排除了 PE。YEARS标准和PEGeD标准的错误率分别为0.4%(95% CI,0.1%-1.1%)和0.5%(95% CI,0.2%-1.2%);两者的有效性相似:结论:在35岁或以下的患者中,PERC和PERC-35算法的安全性和有效性相似。不过,我们报告的置信区间较大,因此无法确认在该年龄组患者中使用这两种工具的安全性。
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