# BEdside Exclusion of Pulmonary Embolism in children without Radiation (BEEPER)

> **NIH NIH R01** · INDIANA UNIVERSITY INDIANAPOLIS · 2020 · $1,937,790

## Abstract

Abstract
No study has been performed to prospectively record the presenting complaints, signs, symptoms and
comorbidities of children who raised the suspicion of pulmonary embolism (PE) in children. Clinicians must
extrapolate what is known about PE in adults to children. This process puts children in harm’s way: most
children with PE go undiagnosed after their first contact with a healthcare provider, meaning diagnosis is often
delayed. Perhaps as a result, the mortality rate of PE is the same in children as it is in adults. On the other
hand, tens of thousands of low risk children and adolescents are unnecessarily exposed to increased lifetime
cancer risk from ionizing radiation from CT scans done to search for PE they do not have. No clinical criteria
have been developed to either estimate the probability of PE in children, or to exclude PE based upon
information available at the bedside. In adults, the Pulmonary Embolism Rule out Criteria, or PERC rule, has
been validated as a method to exclude PE. In this work, we will test a modification of the PERC rule, PERC-
Peds, which uses an age adjustment to heart rate, one of the 8 objective criteria in the PERC rule. This project
will prospectively test if PERC-Peds, can safely exclude PE in 4,030 children aged 5-17 who raise a suspicion
of PE in the emergency department setting. The criterion standard outcome is diagnosis of PE or DVT within
45 days. To reach the study-defined threshold of safety, the top limit of the 95% confidence interval for the
false negative rate of the exclusionary criteria (PERC-Peds) must be lower than 1.5%. Additionally, we will test
the diagnostic accuracy of the D-dimer, in the subset of patients with the test ordered as part of usual care, and
data will be collected for multiple other ancillary aims. This project will also identify which factors truly increase
or decrease the probability of PE outcome in children who raise a suspicion of PE, and may provide a much
needed evidence basis for physicians to have a rational basis to launch a workup for PE, and also provide
clinical criteria to exclude PE without the need for ionizing radiation.

## Key facts

- **NIH application ID:** 9973322
- **Project number:** 1R01HL148247-01A1
- **Recipient organization:** INDIANA UNIVERSITY INDIANAPOLIS
- **Principal Investigator:** ANGELA M ELLISON
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $1,937,790
- **Award type:** 1
- **Project period:** 2020-04-15 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9973322

## Citation

> US National Institutes of Health, RePORTER application 9973322, BEdside Exclusion of Pulmonary Embolism in children without Radiation (BEEPER) (1R01HL148247-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9973322. Licensed CC0.

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