Geneva Score For Pulmonary Embolism

Consists of the original, revised and simplified Geneva risk predictors for pulmonary embolism (PE).

Below the calculator there is more information about each of the scores and about their risk prediction interpretation.


The Geneva Score is aimed at predicting the risk of acute pulmonary embolism and is based on individual risk factors and results from clinical determinations.

There are three versions of the score available: the original, a revised and a simplified one.

The differences between the three and information about the studies they originate from, are provided in the text below the form.


The following table introduces the low, intermediate and high risk PE categories based on the original and revised Geneva score and the unlikely and probable categories from the simplified version of it.

Geneva model Total score PE probability
Original 0 - 5 Low
5 - 8 Intermediate
>8 High
Revised 0 - 3 Low 8%
4 - 10 Intermediate 28%
>11 High 74%
Simplified 0 - 2 Unlikely
>2 Probable

1

Patient age

2

Previous DVT or PE

3

Surgery or fracture in the last 4 weeks

4

Active malignant condition

5

Unilateral lower limb pain

6

Pain on palpation of lower limb and unilateral edema

7

Hemoptysis

8

Heart rate

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1

Patient age

2

Previous DVT or PE

3

Recent surgery in the last 4 weeks

4

Heart rate >100 bpm

5

PaCO2 (partial CO2 pressure)

6

PaO2 (partial O2 pressure)

7

X ray - band atelectasis

8

X ray - hemi diaphragm elevation

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1

Patient age

2

Previous DVT or PE

3

Surgery or fracture in the last 4 weeks

4

Active malignant condition

5

Unilateral lower limb pain

6

Pain on palpation of lower limb and unilateral edema

7

Hemoptysis

8

Heart rate

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The three versions of the Geneva score explained

The Geneva scores are a group of three risk predictors that determine the chances for the patient to suffer from an acute pulmonary embolism.

The calculator above has three different tabs, each with one version of the score.

These are all based on individual risk factors and on routinely performed clinical determinations when PE is suspected.

The items and their significance in the scores are explained further below.

1. The Revised Geneva score which is the most commonly used now, consists of 8 parameters but does not include the result from the arterial blood gas sample found in the original model.

Item in revised Geneva score Points Description
Age >65 1 Age is one of the main PE risk factors.
Previous DVT or PE 3 History of deep venous thrombosis or PE count as risk factors.
Surgery or fracture in the last 4 weeks 2 Due to immobilization during recovery and possible blood vessel damage.
Active malignant condition 2 Cancer patients are at higher risk of PE.
Unilateral lower limb pain 3 This is a symptom suggestive of DVT.
Pain on palpation of lower limb and unilateral edema 4 This is a symptom suggestive of DVT.
Hemoptysis 3 Symptom of PE, consisting in expectoration of blood.
Heart rate 75-94 bpm 3 Increased heart rate may signal PE.
Heart rate >94 bpm 5 Rapid heart rate is sign of pulmonary embolism.

The revised version is based on a derivation and external validation of the score in 2 independent studies on PE that have taken place in 3 university hospitals in Europe on consecutive patients admitted with suspected PE.

The score is considered to be as effective as other PE risk models such as the PERC rule.

2. The Original Geneva score comprises of 8 items and compared to the revised version, gives a higher relevance to age (three age groups instead of two) and also uses the partial pressures of O2 and CO2 in arterial blood.

Item in original Geneva score Answer choices (points)
Age <60 (0)
60 – 79 (1)
≥80 (2)
Previous DVT or PE Yes (2)
Recent surgery in the last 4 weeks Yes (3)
Heart rate >100 bpm Yes (1)
PaCO2 (partial CO2 pressure) <35 mmHg (2)
35 - 39 mmHg (1)
PaO2 (partial O2 pressure) <49 mmHg (4)
49 - 59 mmHg (3)
60 - 71 mmHg (2)
72 - 82 mmHg (1)
X ray - band atelectasis Yes (1)
X ray - hemi diaphragm elevation Yes (1)

The original study involved a cohort of 1090 consecutive patients admitted with suspicion of PE.

27% of patients were diagnosed and a cut off score of 4 points was found to best rule out patients with low probability of PE.

The original Geneva score provides a standardised assessment of the clinical probability of pulmonary embolism, to be used in emergency units.

3. The Simplified Geneva score is the latest variation of the score and was built on the revised version from which it retains the items.

The scoring method is simplified as to make the score easier to remember and each positive element is awarded 1 point.

The only answer choice awarded 2 points is the heart rate above 94 bpm.

The study has used data from 1049 patients from two different diagnostic trials.

The study evaluated the safety of ruling out PE based on clinical probability and results on highly sensitive D-dimer testing.

The results were found to be just as accurate as those from the revised version, however, further validation was recommended.

 

PE clinical probability in the Geneva models

The first two Geneva models stratify patient risk of PE in low, intermediate and high risk categories whilst the simplified version uses the Unlikely/Probable distinction.

This is one step ahead towards an accurate clinical assessment of suspected acute pulmonary and timely intervention.

The table below introduces the assigned risk categories for the original, revised and simplified Geneva scores.

Geneva model Total score PE probability
Original 0 - 5 Low
5 - 8 Intermediate
>8 High
Revised 0 - 3 Low 8%
4 - 10 Intermediate 28%
>11 High 74%
Simplified 0 - 2 Unlikely
>2 Probable
 

Pulmonary embolism causes

PE occurs when the pulmonary artery that carries blood to the lungs is blocked by a blood clot. Most commonly, the origin of the clot is in the deep veins of the legs and is caused by a phenomenon called deep venous thrombosis (DVT).

The main risk factors are sedentarism, conditions that affect the structure of the blood vessels and conditions that increase the chances for blood to clot such as heart failure, thrombophilia or Hughes syndrome.

During inactivity, blood circulation slows down, therefore facilitating the creation of blood clots.

Blood vessel damage refers to narrowing and blockage that prevents normal blood circulation. In some cases, this is accompanied by the inflammation of the blood vessels (vasculitis).

 

References

1. Wicki J, Perneger TV, Junod AF, Bounameaux H, Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med. 2001; 161(1):92-7.

2. Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, Perrier A. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006; 144(3):165-71.

3. Klok FA, Mos IC, Nijkeuter M, Righini M, Perrier A, Le Gal G, Huisman MV. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med. 2008; 168(19):2131-6.


App Version: 1.0.1

Coded By: MDApp

Specialty: Pulmonology

System: Respiratory

Objective: Risk Predictor

Type: Score

No. Of Items: 8

Article By: Denise Nedea

Published On: May 13, 2017 · 07:25 AM

Last Checked: May 13, 2017

Next Review: May 13, 2018