Risk factors
Age > 65 years?
No
Surgery or bone fracture within the last month?
No
Active malignant condition?
No
History of DVT or PE?
No
Clinical findings
Heart rate
<75/min
Unilateral lower limb pain?
No
Unilateral leg edema or pain on deep palpation?
No
Hematoptysis?
No
Result
Revised Geneva Score
2-level scoring system:
Pulmonary embolism unlikely.
The incidence of PE in this group can be expected to be around 16%.
Check the D-dimer level.
3-level scoring system:
The clinical probability of pulmonary embolism is low.
The incidence of PE in this group can be expected to be around 8-10%.
Check the D-dimer level.

The Revised Geneva Score calculator helps you to calculate the probability of Pulmonary Embolism (PE) using eight simple criterion. The PE score you will obtain serves as an additional risk factor when assessing patients with clinical manifestations of Venous ThromboEmbolism (VTE).

Revised Geneva Score

The Revised Geneva Score from 2006 is a simple tool that helps us to predict Pulmonary Embolism in Emergency Department patients. It does not rely on the experience of a doctor as much as the Well's Score, and the Revised Geneva Score is also simpler and easier to apply than the original Geneva Score, since it does not require any invasive measurement methods.

To calculate your patient's Geneva Score, you need to be well aware of all the risk factors and clinical findings enumerated below. Each criterion present in your patient's case is associated with a specific number of points. The sum of all the points scored in a given case is the calculated Revised Geneva Score.

VariablePresentAbsent
Age >65 years10
History of DVT or PE30
Surgery with general anesthesia or a fracture within the last month20
Active malignant process20
Unilateral lower limb pain30
Hemoptysis20
Heart Rate
>75–94/min30
>95/min50
Unilateral lower extremity edema or pain on deep vein palpation40

Interpretation:

There are two different scoring schemes for the Geneva Score: 2 level and 3 level.

2 level classification:

  • 0-5 points - Pulmonary Embolism is unlikely (PE probability: 16%)
  • ≥6 points - Pulmonary Embolism is probable (PE probability: 38%)

3 level classification:

  • 0-3 points - low risk (PE probability: 8-10%)
  • 4-10 points - intermediate risk (PE probability: 22-28%)
  • ≥11 points - high risk (PE probability: 48-74%)

All patients with a low or intermediate risk require their D-dimer level to be evaluated. All the patients at high risk require an urgent CT scan for confirmation.

Patients with low/intermediate risk and an elevated D-dimer level require a CT scan to rule out the diagnosis of PE.

Our D-dimer calculator will help you determine the appropriate cutoff levels specific for your age (created for people who are 50+ years old).

What is Pulmonary Embolism? What do we have to know about it?

Pulmonary Embolism is a serious condition caused by the presence of a clot in a pulmonary artery. The clot itself usually comes from a thrombus formed in a lower limb during an episode of Deep Vein Thrombosis. Even though the patient's lungs are still capable of exchanging oxygen and carbon dioxide, the clogged artery cannot supply the lungs with blood. This process causes severe oxygen shortage, and may lead to rapid heart failure and death.

The most common signs of Pulmonary Embolism include:

  • shortness of breath;
  • chest pain;
  • hemoptysis (coughing up blood);
  • cough;
  • fever;
  • cyanosis (bluish skin);
  • loss of consciousness;
  • signs of Deep Vein Thrombosis; and
  • low blood pressure.

Pulmonary Embolism is lethal in 30% of cases if not diagnosed properly. When assessed and treated correctly in a timely manner, that percentage is decreased to 2%. That's why it's so crucial to detect all the abnormalities in the simplest possible way. Tools such as the Geneva Scale or the Well's Rule were created to unify the criteria used to diagnose Pulmonary Embolism and speed up the whole process, especially in cases with mild symptoms.

Here you can check your own maximal O₂ consumption and your heart risk score.

Pulmonary Embolism criteria

Autopsies suggests that only 20% of Pulmonary Embolism cases are diagnosed when the patient is still alive. Due to the variety of signs and symptoms, each with varied intensity, this condition is often does undiagnosed or misdiagnosed. Usually, both the clinical finding and laboratory tests are not sufficient to make the definitive diagnosis.

The first step in diagnosis is to assess the state of the patient, check their vital signs, rule out other illnesses, and look for specific symptoms (enumerated below). The next step is to perform a D-dimer test and to evaluate the Pulmonary Embolism score, using the Geneva Score calculator (both full or simplified) or the Well's Rule.

  1. Patients in the "low risk" group do not have to undergo any further testing if they do not show any of the criteria listed below:

    • Low oxygen saturation <95%;
    • Age > 50 ;
    • Hormone use;
    • Prior DVT or PE;
    • Recent surgery or trauma;
    • Rapid heart rate;
    • Coughing up blood;
    • Prior Pulmonary Embolism (PE) or Deep Vein Thrombosis (DVT); or
    • Unilateral leg swelling.
  2. If the Revised Geneva Score calculator indicates that Pulmonary Embolism may be the cause of the presenting symptoms, the physician may use one or more of the following techniques to confirm the diagnosis:

    • Computer Tomography (CT) or Angio-CT;
    • Magnetic Resonance Imagining (MRI);
    • X-ray;
    • Ultrasonography (US) and the compression test; or
    • Echocardiography.

Don't hesitate to check our Pulmonary Embolism Rule-Out Criteria calculator!

PE risk score

Higher risk patients are those with:

  • specific symptoms enumerated above (check: Pulmonary Embolism criteria);
  • Geneva Score above 5 points;
  • Well's score above 4 points; and
  • PESI score above 100 points.

Venous Thromboembolism (VTE) prophylaxis

Venous Thromboembolism prophylaxis includes:

  • Accurate anticoagulative treatment;
  • Early mobilization;
  • Compression stocking or device;
  • Proper treatment of a liver or kidneys insufficiency;
  • Early diagnosis of inherited/genetic diseases causing increased clot formation;
  • Efficient treatment of malignancies; and
  • IVC filter - a basket-like device, placed surgically into patient's vena cava.

Simplified Geneva Score

The Simplified Geneva Score was created in 2008 to make the process even easier to perform, and, most importantly, easier to remember. In the simplified version, almost all of the criteria have the same amount of points: 1. The only exception is that a heart rate over 95/min is counted as 2 points.

VariablePresentAbsent
Age >65 years10
History of DVT or PE10
Surgery in general anesthesia or a fracture within the last month10
Active malignant process10
Unilateral lower limb pain10
Hemoptysis10
Heart Rate
>75–94/min10
>95/min20
Unilateral lower extremity edema or pain on deep vein palpation10

Interpretation:

There are also two different scoring schemes for the Simplified Geneva Score: 2 level and 3 level.

2 level classification:

  • 0-2 points - Pulmonary Embolism is unlikely (PE probability: 11.5%)
  • ≥3 points - Pulmonary Embolism is probable (PE probability: 42%)

3 level classification:

  • 0-1 points - low risk (PE probability: 7-9.7%)
  • 2-4 points - intermediate risk (PE probability: 22-29%)
  • ≥5 points - high risk (PE probability: 45-64%)

Many studies have proven that Revised Geneva Score, Simplified Geneva Score and the Well's Rule have a similar clinical probability when taken in consideration along with the patient's D-dimer level.

Łucja Zaborowska

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