- In the setting of a low-risk patient who is not PERC negative, the physician should consider a d-dimer for further evaluation.
- If the d-dimer is negative, and clinical gestalt determines a pre-test probability is <15% then, the patient does not require further testing for PE.
- If the d-dimer is positive, further testing such as a CT-angiography or V/Q scan should be pursued.
- There is no need to apply the PERC rule to those patients who are not being evaluated for PE.
- If the patient is considered low-risk, PERC may help avoid further testing.
- If the patient is moderate or high risk then PERC can not be utilized. Consider d-dimer or imaging based on risk.
- Consider pericardial disease in patients with pleuritic complaints as well.