RCEM Learning February 2025
Feb 13, 2025
In a festive twist for Valentine’s Day, hosts explore the PERC-35 rule for diagnosing pulmonary embolism in younger patients, highlighting key studies and their implications. They also dive into guidelines for handling glucocorticoid-induced adrenal insufficiency, emphasizing the complexities faced by healthcare professionals. Discussions include the challenges of serum glucocorticoid management in emergencies and the vital importance of careful monitoring. Lastly, they touch on pediatric care insights, particularly on dehydration assessment and evaluating pregnant patients.
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PERC-35 Rule Adjusts for Younger Patients
- The PERC-35 rule modifies the PERC for patients 35 or younger, swapping pulse rate >99 for temperature >38.
- This considers fever more predictive in younger patients, highlighting different PE presentation by age.
PERC-35's Limitations in Retrospective Study
- Retrospective registry study showed PERC-35 missed PEs at 0.35% overall but 7% in ages 18-35.
- High miss rate in young likely due to applying rule to confirmed PE cases, not pre-test probability patients.
Don't Use PERC-35 Yet
- Prospective studies following suspected PE patients with pre-test probability assessment are needed to validate PERC-35.
- Emergency clinicians should not yet adopt PERC-35 broadly without such evidence.