Efe KANTER, Elif ERYURT ÖZ, Mehmet Göktuğ EFGAN, Ecem ERMETE GÜLER, Burak ACAR, Uğur TAVŞANOĞLU
Comprehensive Medicine - 2026;18(2):107-112
Objective: Pulmonary embolism (PE) is a life-threatening emergency requiring rapid diagnosis. This study evaluates the diagnostic performance and distribution of the Wells score and Pulmonary Embolism Rule-Out Criteria (PERC) among emergency department (ED) patients who underwent computed tomography pulmonary angiography (CTPA) for suspected pulmonary embolism (PE), and examines how often confirmed PE occurred in patients classified as low risk by these tools. Materials and Methods: We conducted a retrospective observational study in the emergency department of a tertiary hospital. Adult patients (>=18 years) who underwent computed tomography pulmonary angiography (CTPA) for suspected PE between January and December 2023 and in whom Wells and PERC scores could be retrospectively calculated were included. Diagnostic accuracy was analyzed using receiver operating characteristic (ROC) curves. Since the cohort includes only imaged patients, results apply specifically to CTPA-selected populations. Results: We included 299 patients, with a mean age of 67.4+/-16.1 years; 96 (32.1%) had confirmed PE. Among PE-positive cases, 7 (7.3%) had a PERC score of 0, and 42 (43.8%) had Wells <2; 7.3% were low risk by the rules. Wells (2.91+/-2.21 vs. 1.09+/-1.48) and PERC (1.60+/-1.17 vs. 0.82+/-0.85) scores were significantly higher in PE-positive than PE-negative patients (p<0.001). ROC analysis showed AUC 0.771 for Wells and 0.711 for PERC. Negative predictive values were 89.3% (Wells) and 91.2% (PERC). Higher scores correlated with worse outcomes, including ICU admission and mortality (p<0.001). Conclusion: Important PEs occurred even in patients classified as low risk, indicating these scores should support but not replace clinical judgment.
