Which patient scenario meets the Pulmonary Embolism Rule-out Criteria (PERC) to safely rule out PE?

• A. A 45-year-old woman with HTN/DM, HR 92, RR 20, BP 146/90, SpO2 97%
• B. A 60-year-old man with HR 110 and SpO2 92% on room air
• C. A 30-year-old woman with leg swelling and fever
• D. A 50-year-old man with recent surgery

Answer: (A)

PERC is a quick rule-out tool used when a patient has a low pretest probability for pulmonary embolism. If all eight criteria are negative, PE can be safely excluded without further testing. These criteria include being younger than 50, heart rate under 100, oxygen saturation at least 95%, no unilateral leg swelling, no hemoptysis, no recent surgery or trauma within 4 weeks, no prior DVT/PE, and not using estrogen.

In the described scenario, the patient is 45 years old, with a heart rate of 92, and an oxygen saturation of 97% on room air. There’s no information given about leg swelling, prior DVT/PE, recent surgery, or estrogen use, so all criteria are satisfied. Therefore, this patient meets the PERC rule-out and PE can be safely ruled out without further testing.

The other scenarios fail because they have at least one positive PERC criterion: one has age not under 50 or abnormal vitals with hypoxemia, another has leg swelling, and another has recent surgery (with age not under 50).