Geneva — clinical probability of pulmonary embolism

Interactive tool

Calculate the score

The calculator returns both the revised and the simplified score, with the three-level and the dichotomous stratification. The points shown next to each item are those of the revised version.

How to use it

Instructions

The two versions

• Revised Geneva (Le Gal G. et al., Ann Intern Med 2006): weights ranging from 1 to 5 points. This is the original validated version.
• Simplified Geneva (Klok FA. et al., Arch Intern Med 2008): each item scores 1 point, except heart rate ≥ 95 bpm, which scores 2. Easier to use at the bedside, with essentially comparable performance.

The calculator shows both results: use the one specified by your department's protocol and apply it consistently.

The two stratifications

Notes on the individual criteria

• Surgery or fracture within 1 month: surgery under general anaesthesia or lower-limb fracture in the previous 4 weeks.
• Active malignancy: solid or haematological cancer currently treated or considered active, or cured less than 1 year ago.
• Unilateral lower-limb pain: a symptom reported by the patient, regardless of the physical examination.
• Pain on deep palpation + unilateral oedema: an objective sign that requires both elements. It scores 4 points in the revised version.
• Heart rate: the two bands (75–94 and ≥ 95 bpm) are mutually exclusive; the calculator derives the band from the value entered.

Clinical references

Guidelines and interpretation

Use in the diagnostic pathway

1. Low or intermediate probability (or “unlikely” in the dichotomous model) → high-sensitivity D-dimer. If negative, PE is ruled out; if positive, CT pulmonary angiography.
2. High probability (or “likely”) → direct CT pulmonary angiography, without D-dimer. In haemodynamically unstable patients, bedside echocardiography to look for right ventricular overload, and thrombolysis if the clinical picture requires it.
3. In low-probability patients the PERC rule can be applied first: if negative, it avoids the D-dimer test as well.

Geneva or Wells?

The 2019 ESC guidelines place the two scores on the same level (class I, level A for the use of a validated score). The choice is pragmatic:

• Geneva is preferable when reproducibility between different clinicians is needed, in settings with high staff turnover or in clinical research, because all its variables are objective.
• Wells is quicker and, through the alternative-diagnosis criterion, captures clinical information that no objective variable can replace; but it depends on the experience of the person applying it.
• Both have moderate discriminating power (area under the ROC curve around 0.74–0.78): neither is sufficient on its own, and it is always the combination with D-dimer that makes exclusion safe.

After diagnosis: prognostic stratification

Geneva estimates the probability that PE is present, not its severity. Once the diagnosis is confirmed, early mortality risk stratification is based on haemodynamic instability, the PESI or sPESI index, signs of right ventricular dysfunction on imaging and biomarkers (troponin, BNP). These are two different questions and should be kept separate in the report and in the medical record.

References

Sources

• Le Gal G. et al., Ann Intern Med 2006 — Prediction of pulmonary embolism in the emergency department: the revised Geneva score.
• Klok FA. et al., Arch Intern Med 2008 — Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism.
• ESC 2019 — Guidelines for the diagnosis and management of acute pulmonary embolism.
• Ceriani E. et al., J Thromb Haemost 2010 — Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis.