PERC Prediction and D-dimer in the diagnosis of acute pulmonary embolism

Introduction: Acute pulmonary embolism (PE) is a life-threatening condition requiring immediate detection and management. The Pulmonary Embolism Rule-Out Criteria (PERC) and D-dimer have emerged as effective tools for PE identification. Objective: our analysis aims to explore existing studies on the efficiency of the PERC rule and D-dimer in diagnosing acute PE and determine whether their combined application enhances diagnostic accuracy and risk stratification in individuals suspected of having PE. Methods: A comprehensive search was conducted in medical databases, including PubMed, EMBASE, and Cochrane Library, to identify relevant research evaluating the PERC rule and D-dimer in identifying PE. Results: thirty-five studies were included in the literature review. The majority demonstrated that the PERC rule and D-dimer are valuable tools for identifying PE, with high sensitivity and negative predictive value. The PERC approach is particularly useful in individuals with low clinical risk, while D-dimer is more effective when combined with clinical probability scores. The combined use of both can increase specificity and optimize clinical decision-making. Conclusion: the literature review supports that the PERC rule and D-dimer can enhance diagnostic accuracy and risk stratification, enabling more effective clinical decision-making and avoiding additional imaging tests in individuals at low risk of PE. Further research is needed to refine further the implementation of these tools in medical practice and specific population groups