The Cardiovascular
ToolsCalculators

PERC rule for pulmonary embolism

Rules out PE in low-probability patients without further testing.

PERC rule for pulmonary embolism
Age ≥50 years
Heart rate ≥100 /min
O₂ saturation <95 % on room air
Haemoptysis
Oestrogen use
Prior DVT or PE
Recent surgery or trauma (≤4 weeks, needing hospitalisation)
Unilateral leg swelling
ResultPERC negative

All eight criteria absent — in a patient already judged low pre-test probability, PE can be excluded without D-dimer or imaging (<2 % risk).

When to use

  • Only in patients you have already judged to be at low clinical (gestalt) pre-test probability of PE. PERC is not valid in moderate- or high-probability patients.

Formula

PE can be excluded when all eight are absent: age ≥50, HR ≥100, SpO₂ <95%, haemoptysis, oestrogen use, prior VTE, recent surgery/trauma, unilateral leg swelling.

Pearls and pitfalls

  • Applying PERC to a patient who is not low pre-test probability re-introduces the missed diagnoses it was designed to avoid — the two steps are sequential.

References

  1. Kline JA, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247–55.