The Revised Geneva Score is an objective clinical decision rule used to assess the pre-test probability of Pulmonary Embolism (PE).
Objective Assessment
The diagnosis of PE is notoriously difficult because its symptoms (shortness of breath, chest pain, tachycardia) are non-specific and overlap with many other common conditions like pneumonia, heart failure, or anxiety. While the Wells Criteria is widely used, it relies on a subjective assessment of whether PE is the "most likely" diagnosis. The Revised Geneva Score was developed to remove this subjectivity, relying entirely on factual, observable clinical variables.
Variables and Scoring
The score assigns points based on:
- Age > 65
- Previous history of DVT or PE
- Recent surgery or fracture
- Active malignancy
- Unilateral lower limb pain
- Hemoptysis
- Heart rate severity (75-94 bpm vs ≥ 95 bpm)
- Pain on lower limb deep venous palpation with unilateral edema
Revised Geneva Score = Sum of weighted points for clinical features.
Where:
Heart Rate=
Scores highly (up to 5 points) depending on tachycardia severity.Unilateral Leg Pain/Edema=
Strong indicators of concomitant DVT, raising PE probability.Clinical Pathway
- Low Probability (0-3): A negative D-dimer can safely rule out PE.
- Intermediate Probability (4-10): A negative D-dimer can usually rule out PE, but positive results require imaging.
- High Probability (≥ 11): D-dimer is largely unhelpful as a negative result does not confidently rule out PE; these patients generally proceed directly to computed tomography pulmonary angiography (CTPA).