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    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
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    Altitude-Adjusted PERC Rule

    Rules out PE if no criteria are present; includes SaO2 adjustment for altitude.

    INSTRUCTIONS

    This tool is intended for patients with low risk for PE and who live at high altitude (>4000 ft). 

    When to Use
    Pearls/Pitfalls
    Why Use
    • In patients who present to the emergency department with chest pain or dyspnea and have a low pre-test probability for PE. 

    • A negative PERC-Altitude means PE can be ruled out and does not require further work-up (D-dimer or CTPA).

    • This test is for patients who live at high altitude (>4000 ft). Use the original PERC Rule for patients who live at low altitudes.

    • Most importantly this differs from the original PERC rule in that it is intended for use at high altitude (>4000 ft) and includes an O2 cutoff of 90% as opposed to 95%..

    • This tool is only meant for patients who are low risk of a PE (<15%, based on Wells' Score or clinician gestalt).

    • An inexperienced clinician may underestimate the pre-test probability of a PE and use this tool inappropriately.

    • This version of the PERC Rule should not be used for patients who live at low altitudes.

    • A patient with low pre-test probability for PE (<15%) and a negative PERC-Altitude test does not need D-dimer or CTPA.

    • Can help reduce overtesting.

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    Next Steps
    Evidence
    Creator Insights
    Dr. Jeffrey Kline

    About the Creator

    Jeffrey Kline, MD, is a professor of emergency medicine and physiology and the vice chair of research at Indiana University. Among other research, he has conducted clinical studies using breath-based methods to diagnose and assess the severity of PE. He co-founded BreathQuant Medical Systems Inc to advance practical applications of 16 patents for medical devices. Dr. Kline has published over 50 manuscripts in the area of PE.

    To view Dr. Jeffrey Kline's publications, visit PubMed

    Are you Dr. Jeffrey Kline? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Dr. Stephen J. Wolf

    About the Creator

    Stephen J. Wolf, MD, is a professor of emergency medicine at the University of Colorado School of Medicine in Denver, CO. He is also the director of service at Denver Health Emergency Medicine. Dr. Wolf’s primary research is focused on evaluation of adult patients presenting to the ED with suspected acute venous thromboembolic disease.

    To view Dr. Stephen J. Wolf's publications, visit PubMed

    Are you Dr. Stephen J. Wolf? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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