The following is a summary of “Pulmonary Embolism Rule-out Criteria: Diagnostic Accuracy and Impact of COVID-19,” published in the December 2024 issue of Emergency Medicine by Tanir et al.
The Pulmonary Embolism Rule-Out Criteria (PERC), intended to reduce unnecessary testing in low-risk pulmonary embolism (PE) cases, has not been adequately validated for use in COVID-19.
Researchers conducted a retrospective study to assess the validity of the PERC in patients admitted to emergency department who underwent computed tomography pulmonary angiography (CTPA) during the COVID-19 pandemic.
They analyzed patients in emergency department who underwent CTPA for suspected PE, COVID-19 status was determined by reverse transcription-polymerase chain reaction (RT-PCR) results from the emergency department or within 30 days prior to the visit. Data on demographics, symptoms, d-dimer levels, and relevant medical history were collected. The PERC was applied, considering factors such as age, oxygen saturation, heart rate, and the absence of hemoptysis or recent trauma. Outcomes were categorized based on concordance between PERC results and CTPA findings, with specific definitions for true positives, true negatives, false positives, and false negatives. The impact of COVID-19 status on the diagnostic performance of PERC was evaluated by analyzing the prevalence of patients with PE, along with positive and negative COVID-19 tests.
The results showed that among 2,430 participants, 45.1% tested negative for COVID-19, 43.4% tested positive, and 11.5% were untested. The PERC identified 91.2% of cases as positive, but only 6.9% were confirmed with PE. Discordant results between PERC and CTPA were observed in 84.9% of cases (n = 2,062). Statistical analysis revealed low diagnostic concordance between PERC positivity and actual PE presence (P = 0.001; P < 0.01). In patients with positive- COVID-19, PERC showed 95.3% sensitivity (95% CI: 86.91–99.02), 9.1% specificity (95% CI: 7.46–11.15), 6.3% positive predictive value (95% CI: 6.01–6.70), 96.8% negative predictive value (95% CI: 90.81–98.94), and 14.4% accuracy (95% CI: 12.34–16.67). For patients with negative COVID-19, sensitivity was 95.4% (95% CI: 88.64–98.73), specificity was 7.8% (95% CI: 6.25–9.66), positive predictive value was 8.1% (95% CI: 7.83–8.57), negative predictive value was 95.1% (95% CI: 88.11–98.14), and accuracy was 14.7% (95% CI: 12.73–17.02).
Investigators concluded the PERC demonstrated comparable sensitivity and negative predictive value in patients with positive and negative COVID-19, its clinical utility may be limited due to potential for unreliable results when used as the sole diagnostic tool.
Source: sciencedirect.com/science/article/abs/pii/S0736467924001926
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