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Commonly used CDM tools relevant to PEs, or suspected PEs - written in the negative for convenience. Make sure to be aware of the limitations of the scoring systems and only even consider using them after a reasonable history and examination.

WRITTEN IN THE NEGATIVE:

High Gestalt Factors: There are no high gestalt reasons for suspecting a pulmonary embolus. No new shortness of breath on exertion without a clear precipitant such as asthma, pneumonia, or heart failure. Not pregnant. No recent long flights or car trips. No history of malignancy/neoplasm. No known family history of thrombophilia. No previous VTE. There is no clinical evidence of RH strain – no distended neck veins w normal JVP, no LL oedema, no RUQ pain/tenderness. POCUS TTE shows a collapsing IVC, without any features of acute RH Strain (such as the D sign / hyperkinetic apex & hypokinetic RV mid free wall – McConnel’s)

PE Rule Out Criteria: *All* PE Rule out criteria for this low gestalt (for VTE) presentation are met: Patient is under 50yo, non tachycardic (HR < 100), not hypoxic (SpO2 > 95%), has no unilateral leg swelling, no haemoptysis, no recent surgery or trauma (eg limb cast or bedrest), no history of VTE (PE or DVT), and no exogenous estrogen (including the OCP and HRT).

WELLS-PE is being applied after assessment (hx/ex) suggests that VTE is a diagnostic possibility evidenced by PLACEHOLDER_GESTALT_FACTOR. There is no unilateral limb swelling or tenderness (0/3). The likely diagnosis is not a pulmonary embolism – current working diagnosis is PLACEHOLDER (0/3). There is no tachycardia with HR < 100 (0/1.5). No history of immobilization for 3 days or more, or surgery in the last 4 weeks (0/1.5). No history of VTE such as PE, DVT, or any other deep venous thrombotic events (0/1.5). No haemoptysis (0/1). No history of malignancy with treatment in the last six months (0/1).

IMPORTANT NOTES:

Do not apply WELLS PE for patients without a gestalt for PE. Just because “Chest Pain” is scribbled down by the triage note does not mean you should be applying scoring systems for them. A common mistake is to reflexively apply a risk scoring metric for generic presenting complaints. Only after a focused history/examination should any scoring system be applied – if it is even applicable in the first place.

PERC does not apply to high gestalt patients. A pregnant lady coming off a long haul flight with unilateral thigh pain who develops sudden onset shortness of breath after getting off the plane without any obvious cause like bronchospasm will clear the PERC.