π« Revised Geneva Score
PE probability from 8 clinical variables.
For informational purposes only, not medical advice. Consult a healthcare professional.
The Revised Geneva Score estimates the clinical probability of pulmonary embolism from eight fully objective variables, no gestalt required. It was designed as the reproducible alternative to the Wells score, which leans on clinical judgment. Points run 0 to 22: 0 to 3 is low probability, 4 to 10 intermediate, and 11 plus high, with PE prevalence around 8, 28, and 74 percent respectively in validation. The simplified two-level version calls 0 to 5 PE-unlikely and 6 plus PE-likely. This calculator gives both readings for emergency clinical reference.
How to Use This Calculator
Enter the age and heart rate bands, then check the clinical factors present. The score gives both the three-level and the simplified two-level PE probability.
Set the age band and the heart rate band. Tachycardia carries the heaviest single weight in this score.
Check each clinical factor present. Leg symptoms and prior VTE dominate the points.
Read the probability level. Low pairs with D-dimer testing; high usually proceeds to CT.
How the Math Works
Age over 65 scores 1; heart rate 75 to 94 scores 3 and 95 or above scores 5; previous DVT or PE scores 3; surgery or fracture within a month scores 2; active malignancy scores 2; unilateral lower limb pain scores 3; hemoptysis scores 2; and pain on deep palpation with unilateral edema scores 4. The three-level interpretation is 0 to 3 low, 4 to 10 intermediate, 11 or more high. The two-level version, validated for pairing with D-dimer, is 0 to 5 PE-unlikely and 6 or more PE-likely. Low probability plus a negative high-sensitivity D-dimer safely excludes PE; intermediate and high need imaging.
Worked Example
A 70-year-old with heart rate 88, unilateral leg pain (+3), and recent knee surgery (+2) scores 9 points: 1 for age, 3 for the heart rate band, 3 for leg pain, 2 for surgery. The calculator reads this as Intermediate probability on the three-level scale and PE likely on the two-level scale. That combination points to CT pulmonary angiography rather than D-dimer, since the probability is too high for D-dimer to rule out.
Reading Your Result
Low probability with a negative D-dimer excludes PE without imaging. Intermediate probability needs D-dimer first, then CT if positive, though many clinicians image directly. High probability or PE-likely generally goes straight to CT, and anticoagulation is sometimes started while awaiting the scan when suspicion is strong. The score standardizes the pretest probability that all PE testing pathways depend on; it never diagnoses PE by itself.
| Score | Three-level | Two-level |
|---|---|---|
| 0-3 | Low (~8%% PE) | PE unlikely (0-5) |
| 4-5 | Intermediate | |
| 6-10 | Intermediate (~28%%) | PE likely (6+) |
| 11+ | High (~74%%) |
Limitations
The score needs complete data; missing variables understate risk. It was validated in emergency department patients with suspected PE, not inpatients or pregnant patients. Objective does not mean perfect: prevalence figures are cohort averages. Clinical judgment still integrates the story the variables miss, and PERC remains the tool for ruling out without testing in the lowest-risk group.
Related Calculators
Related tools: PERC rule calculator Padua VTE risk score DVT risk: Padua score.
For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
What is the Revised Geneva Score?
An 8-item clinical prediction rule for pulmonary embolism probability, using only objective variables: age, heart rate, and six history and exam items. Scores 0 to 3 are low probability, 4 to 10 intermediate, 11+ high. The two-level version splits at 5/6 for PE-unlikely versus likely.
How is Geneva different from Wells?
Geneva uses fully objective items while Wells includes the subjective judgment that PE is the most likely diagnosis. Geneva is more reproducible between clinicians; Wells is slightly more studied. Both feed the same testing pathways and perform similarly.
What do I do with a low Geneva score?
Pair it with a high-sensitivity D-dimer: negative D-dimer excludes PE, positive D-dimer leads to CT. Low probability alone does not exclude; the combination does. This is the standard evidence-based pathway.
What does PE-likely mean on the two-level score?
A score of 6 or more, where PE is likely enough that D-dimer cannot safely rule it out. These patients generally proceed to CT pulmonary angiography. Some clinicians start anticoagulation while awaiting imaging if suspicion is strong.
Why does heart rate score so heavily?
Because tachycardia was among the strongest PE predictors in the derivation data, and the score weights items by their predictive strength. A heart rate over 95 alone contributes 5 points, nearly reaching PE-likely by itself.
Can the Geneva score rule out PE by itself?
No. It estimates probability; ruling out needs the probability plus a negative D-dimer, or PERC in the lowest-risk patients. A low score is the setup, not the conclusion.
Is the score valid in pregnancy?
Not formally. Pregnancy alters heart rate and was excluded from validation, and D-dimer rises physiologically in pregnancy. Pregnant patients with suspected PE follow pregnancy-adapted algorithms with clinician judgment.
What is the prevalence at each level?
Roughly 8%% for low, 28%% for intermediate, and 74%% for high in the validation cohorts. These anchor the testing thresholds: imaging for high, D-dimer-gated for low and intermediate. Individual risk varies around these averages.
Does a high score mean start blood thinners now?
Guidelines allow empiric anticoagulation while awaiting imaging when PE is strongly suspected and bleeding risk is acceptable. It is a judgment call balancing clot risk against bleeding, not an automatic order from the score.
Which score should our ED use?
Whichever the department standardizes on, since consistency beats small accuracy differences. Geneva suits teams wanting objectivity; Wells suits experienced clinicians comfortable with gestalt. The key is pairing the score with the right D-dimer pathway every time.