Geneva Score for Pulmonary Embolism

Select all criteria that apply to the patient. A score ≥ 4 suggests intermediate to high probability of PE.

Age > 65 years

Patient is older than 65 years

Previous DVT or PE

History of documented deep vein thrombosis or pulmonary embolism

Surgery or fracture within 1 month

Major surgery or fracture requiring immobilization in the past month

Active malignancy

Active cancer (treatment ongoing, within 6 months, or palliative)

Unilateral lower limb pain

Pain in one lower extremity

Hemoptysis

Coughing up blood

Pain on lower limb deep venous palpation and unilateral edema

Tenderness on deep venous palpation with swelling in one leg

Heart Rate

Patient's heart rate on presentation

Clinical Notes:

• Score 0-3: Low probability (8% prevalence)
• Score 4-10: Intermediate probability (28% prevalence)
• Score ≥ 11: High probability (74% prevalence)
• More objective than Wells Criteria - less dependent on clinical judgment
• D-dimer testing is most useful in low and moderate probability cases

Geneva Score for Pulmonary Embolism

The Geneva Score is a validated clinical prediction rule used to assess the probability of pulmonary embolism (PE) in patients presenting with symptoms suggestive of PE. This score provides an alternative to the Wells Criteria and is particularly useful in emergency department settings.

Scoring Criteria

The Geneva Score assigns points based on clinical features and risk factors:

Clinical Feature	Points
Age > 65 years	+1
Previous DVT or PE	+3
Surgery or fracture within 1 month	+2
Active malignancy	+2
Unilateral lower limb pain	+3
Hemoptysis	+2
Heart rate 75-94 bpm	+3
Heart rate ≥ 95 bpm	+5
Pain on lower limb deep venous palpation and unilateral edema	+4

Probability Stratification

Score	Probability	Prevalence of PE
0-3	Low	8%
4-10	Intermediate	28%
≥ 11	High	74%

Clinical Application and Management

The Geneva Score helps guide diagnostic strategies:

Low Probability (0-3 points):
- Consider D-dimer testing first
- If D-dimer is negative, PE can be safely ruled out
- If D-dimer is positive, consider imaging studies
Intermediate Probability (4-10 points):
- Consider D-dimer testing and/or imaging studies
- CT pulmonary angiogram or V/Q scan may be appropriate
- Clinical judgment should guide the diagnostic approach
High Probability (≥ 11 points):
- Consider immediate imaging studies
- D-dimer testing may not be necessary
- High clinical suspicion warrants prompt evaluation

Comparison with Wells Criteria

The Geneva Score offers several advantages:

Objective criteria: Less dependent on clinical judgment compared to Wells Criteria
Reproducible: More standardized scoring system
Validated: Extensively validated in multiple studies
Emergency department friendly: Designed for rapid assessment

Important Considerations

The Geneva Score should be used as part of a comprehensive clinical assessment:

It is most useful when combined with other clinical information
The score helps reduce unnecessary imaging in low-probability cases
It should not replace clinical judgment in high-risk situations
Consider patient-specific factors that may not be captured by the score
Age-adjusted D-dimer cutoffs may be more appropriate in certain populations

This tool has been extensively validated and is widely used in emergency departments and other acute care settings to help manage patients with suspected pulmonary embolism.

References

Le Gal, G., Righini, M., Roy, P. M., Sanchez, O., Aujesky, D., Bounameaux, H., & Perrier, A. (2006). Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Annals of internal medicine, 144(3), 165-171.
Wells, P. S., Anderson, D. R., Rodger, M., Ginsberg, J. S., Kearon, C., Gent, M., ... & Kovacs, M. J. (2000). Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thrombosis and haemostasis, 83(3), 416-420.
Kearon, C., Akl, E. A., Comerota, A. J., Prandoni, P., Bounameaux, H., Goldhaber, S. Z., ... & Kahn, S. R. (2012). Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2_suppl), e419S-e496S.
Righini, M., Van Es, J., Den Exter, P. L., Roy, P. M., Verschuren, F., Ghuysen, A., ... & Le Gal, G. (2014). Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA, 311(11), 1117-1124.

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