Revised Geneva Score Calculator - PE Pretest Probability Tally

The revised Geneva score is a bedside pretest probability tool for pulmonary embolism that uses eight clinical items, age, and a heart rate band to give a 0 to 25 total read against the 0 to 3, 4 to 10, and 11 or higher probability bands. The score helps clinicians decide whether to send a D-dimer, proceed directly to imaging, or look for an alternative diagnosis. It is the simplified, all-clinical successor to the 1997 Geneva rule, which required an arterial blood gas.

• • Emergency department triage for suspected PE: A patient with sudden shortness of breath, chest pain, or tachycardia who needs a structured score.
• • Inpatient risk review after recent surgery: A post-operative patient with new unilateral leg swelling and tachycardia who needs a structured score.

Pulmonary embolism is common and often missed. The Le Gal 2006 derivation cohort reported an overall PE prevalence of 23 percent across 965 emergency-department patients, with band-specific prevalences of 7.8, 28.5, and 73.6 percent. A structured pretest probability score is the foundation of the modern workup.

The calculator mirrors the published eight-item layout. Each item is scored from 0 to 5 points, the items are added, and the total is read against the 0 to 3, 4 to 10, and 11 or higher bands.

When the bedside review raises a question of heparin-induced thrombocytopenia alongside the PE workup, 4TS Score supports the parallel structured review of platelet fall, timing, thrombosis, and other causes that the team often runs in the same shift.

The calculator walks through the eight items, scores each 0 to 5 points, sums the points, and returns the 0 to 25 total alongside the published probability band and the Le Gal 2006 derivation-cohort PE prevalence.

The 0 to 3, 4 to 10, and 11 or higher bands are the published thresholds from Le Gal et al. (Annals of Internal Medicine, 2006), and the calculator honors those boundaries exactly.

According to Le Gal et al. (Annals of Internal Medicine, 2006), the revised Geneva score uses eight clinical items to give a 0-3 low, 4-10 intermediate, and 11 or higher high probability band, with derivation-cohort PE prevalences of about 8%, 28%, and 74% respectively.

According to the 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism (European Heart Journal, 2020), the revised Geneva score is presented as a fully clinical pretest probability rule whose eight items and 0-3, 4-10, and 11 or higher bands are used together to gate the D-dimer and imaging workup, and they recommend it as one of two validated options alongside the Wells score.

When the band lands in the low or intermediate range and a D-dimer is the next step, Age-Adjusted D-Dimer Calculator supports the age-adjusted cutoff that pairs naturally with the score in the same PE workup pathway.

Four of the eight items tend to drive the band in real-world cases.

The eight items are read together. A high heart rate band without a clear risk factor is suggestive but not enough on its own. The 0 to 3, 4 to 10, and 11 or higher bands are the thresholds from the Le Gal 2006 derivation cohort, reproduced in independent validation studies.

When the active-malignancy or prior-clot items point the team toward a broader venous thromboembolism review, VTE Risk Pregnancy Calculator supports the pregnancy-specific VTE risk review that runs alongside the bedside workup in obstetric workflows.

Treat the calculator as a structured checklist for the bedside assessment of suspected pulmonary embolism. Work through the items in any order, but record the inputs and the band so the next reviewer can challenge the score.

1. 1 Enter the patient's age and heart rate: Enter age in years and the bedside heart rate. The age item adds 1 point only when age is greater than 65. The heart rate item maps to 0, 3, or 5 points under the 75 and 95 bpm bands.
2. 2 Confirm the history and risk-factor items: Tick previous DVT or PE, surgery or lower-limb fracture within 1 month, active malignancy, and unilateral lower-limb pain.
3. 3 Confirm hemoptysis and the combined exam sign: Tick hemoptysis for coughing up blood. Tick pain on palpation with unilateral edema only when pain on deep palpation AND unilateral edema of the lower limb are both present.
4. 4 Read the band and pair it with the workup: Add the eight items, read the total against the 0-3, 4-10, and 11 or higher bands, and pair the band with the D-dimer and imaging pathway.

A practical use: a 70-year-old with active breast cancer, a heart rate of 100 bpm, and hemoptysis, but no leg pain or edema. The sub-items are age 1, active malignancy 2, hemoptysis 2, heart rate 100 bpm 5. The total is 10, which places the case in the intermediate band and triggers a D-dimer before imaging.

When the bedside heart rate is on the 75 or 95 bpm boundary and the team wants a rhythm-strip cross-check before scoring the heart rate band, ECG Heart Rate Calculator supports the ECG-based heart rate confirmation that anchors the heart rate item in the score.

A revised Geneva review can be done in the chart with a pen, but a calculator makes the tally consistent, traceable, and easier to defend.

• • Standardised review across providers: Emergency physicians, hospitalists, nurse practitioners, and trainees use the same eight items, so the discussion is less dependent on memory of the original 2006 table.
• • Transparent record-keeping: Each item and the total can be quoted in the chart note, so a later reviewer can challenge the inputs and the band rather than guessing at the reasoning.
• • Quick link to the published derivation cohort: The calculator ties the band to the Le Gal 2006 derivation-cohort PE prevalences (about 8%, 28%, and 74%), so the user does not have to re-look up the numbers.
• • Pairs naturally with the D-dimer and imaging workup: A low band supports a D-dimer-led rule-out, an intermediate band gates D-dimer before imaging, and a high band supports moving directly to CT pulmonary angiography or V/Q scan.

The revised Geneva scoring tool was designed to make the pretest probability of PE easier to discuss at the bedside. The calculator keeps that goal front and centre but does not diagnose PE, prescribe an anticoagulant, or replace imaging.

Several things can move the score up or down, and several things the score does not capture at all.

• • The revised Geneva score is a pretest probability tool, not a diagnostic test. A low score reduces the probability of PE but does not exclude it; symptoms, risk factors, pregnancy status, recent surgery, and clinician judgment still matter.
• • Inter-rater agreement is moderate, and the score has been criticized for over-scoring older patients because the age item and the age-adjusted D-dimer cutoff can compound. Pair the band with the age-adjusted D-dimer cutoff when the patient is over 50 to reduce false-positive imaging.

Bleeding risk, kidney function, pregnancy status, contrast allergy, and the patient's overall hemodynamic stability matter for what to do with the result, but those are not part of the scoring tool.

According to NICE Guideline NG158 (Venous thromboembolic diseases: diagnosis, management and thrombophilia testing), a validated pretest probability tool such as the revised Geneva score should be used to choose between a D-dimer-led rule-out and definitive imaging in suspected pulmonary embolism, and the resulting band should drive the workup rather than D-dimer ordering alone.

When the band lands in the intermediate or high range and the next step is CT pulmonary angiography with iodinated contrast, GFR Calculator supports the kidney-function review that the team usually runs before contrast imaging is ordered.