Altitude-Adjusted PERC Rule
Last Updated / Reviewed: June 2022
Rules out PE if no criteria are present and pre-test probability is < 15%

INSTRUCTIONS

This tool is intended for patients with low risk for PE and who live at high altitude (> 4,000 ft).
High altitude (> 4,000 ft)?
Age ≥ 50?
Heart rate ≥ 100?
O2 Sat on RA < 90%?
Prior Hx of DVT or PE?
Trauma or surgery within 4 weeks requiring general anesthesia?
Hemoptysis?
Exogenous estrogen (oral contraceptives, hormone replacement or estrogenic hormones use in female or male patients)?
Unilateral leg swelling?
Related Calculators Wells' Criteria for PE HEART Score PERC Rule
Altitude-Adjusted PERC Score:

Result:

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Additional
Info

Using the PERC Rule

If the Altitude-Adjusted PERC Rule is satisfied or “negative” and there is 1) a low clinical suspicion of PE (i.e., Gestalt), or 2) PE is unlikely based upon Well’s or other clinical prediction rule. The current literature indicates that the likelihood of pulmonary embolism is less than 2% and there is no need for further work up for PE.
Reference

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: 1247–55.

2. Kline JA, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008; 6: 772–80. (PMID: 18318689).

3. Madsen T, Jedick R, Teeples T, Carlson M, Steenblik J. Impact of altitude-adjusted hypoxia on the Pulmonary Embolism Rule-out Criteria. Am J Emerg Med. 2019;37(2):281-285.

DISCLAIMER

All calculations must be confirmed before use. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither The Sullivan Group (TSG) nor any other party involved in the preparation or publication of this site shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.
Calculations should not be used alone to guide patient care nor should they substitute for clinical judgment.
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