Revised Geneva Score for Pulmonary Embolism
Validated pre-test probability score for pulmonary embolism in the emergency department. Uses only clinical variables (no ABG required), making it highly practical. Validated in multiple international cohorts.
Score interpretation
Revised Geneva 0-3 -- low probability PE; D-dimer to exclude if low clinical suspicion
→ D-dimer ELISA: if negative (< 500 ng/mL -- or age-adjusted threshold [age x 10 ng/mL if > 50 years]): PE excluded; if positive: CTPA; if YEARS algorithm used: add Wells score context (if no signs DVT, PE not most likely, no haemoptysis AND D-dimer < 1000: PE excluded without CTPA); anticoagulation NOT started until PE confirmed; if clinical suspicion very high despite low score: proceed to CTPA.
Revised Geneva 4-10 -- intermediate probability; a normal highly sensitive D-dimer excludes PE, otherwise CTPA
→ Highly sensitive D-dimer first: a normal result excludes PE without imaging at low or intermediate probability (ESC 2019); if raised, CTPA (CT pulmonary angiography): if positive, diagnose PE and anticoagulate; a negative CTPA excludes PE at intermediate probability (V/Q scan if CTPA is contraindicated); initiate anticoagulation if delay to imaging > 4 hours and no contraindication (LMWH therapeutic dose); PESI score for risk stratification once confirmed; outpatient management criteria (sPESI = 0): may be suitable for home treatment with rivaroxaban or apixaban.
Revised Geneva >= 11 -- high probability; immediate CTPA and anticoagulation
→ Start therapeutic anticoagulation IMMEDIATELY while awaiting imaging (adults: LMWH 1.5 mg/kg SC or UFH 5000 IU bolus); urgent CTPA; bedside echocardiography if haemodynamically unstable (assess RV function -- bedside echo faster than CTPA in arrest/near-arrest); PESI/sPESI score for severity; if massive PE (SBP < 90 or shock): thrombolysis (adults: alteplase 100 mg over 2h) if no contraindications; catheter-directed thrombolysis or surgical embolectomy if systemic thrombolysis contraindicated; CTPA if haemodynamically stable regardless of delay; V/Q scan only if CTPA contraindicated (allergy, renal failure, pregnancy). Children: use a children's formulary.
Interpretation bands for the Revised Geneva Score. Apply clinical judgement and local guidance.
References
- Le Gal G et al. Prediction of pulmonary embolism in the emergency department: the Revised Geneva Score. Ann Intern Med. 2006;144(3):165-171.
- NICE NG158. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. NICE. 2020 (updated 2023).
- Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2020;41(4):543–603.
Related
Curated clinical cross-links plus same-class fallbacks.
- HERDOO2 Rule for Discontinuing Anticoagulation in Unprovoked VTE · Venous Thromboembolism
- RIETE Score for Bleeding Risk in VTE · Venous Thromboembolism
- Wells Criteria for PE · Venous Thromboembolism
- Wells Criteria for DVT · Venous Thromboembolism
- PERC Rule for PE · Venous Thromboembolism
- Revised Geneva Score for PE · Venous Thromboembolism
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
