Revised Geneva score (simplified)
Clinical pre-test probability of pulmonary embolism, one point per item
- ESC 2019 PE guideline
- AWMF S2k VTE 2023
- Geneva (CH) / Leiden (NL)
Sources last checked: 2026-10-13
Revised Geneva score (simplified)
Clinical pre-test probability of pulmonary embolism, one point per item
Simplified version: heart rate ≥ 95 /min scores 2, every other item 1. Do not mix with the original weighted Geneva score (cut-offs 0–3 / 4–10 / ≥ 11). Two-level reading: 0–2 PE unlikely, ≥ 3 PE likely. Only for haemodynamically stable patients.
Interpretation
| 0–1 — low clinical probability | Two-level scheme: PE unlikely (0–2). In the ESC 2019 algorithm the next step is D-dimer; a normal result excludes PE without imaging. |
|---|---|
| 2–4 — intermediate clinical probability | Two-level scheme: 2 = PE unlikely, 3–4 = PE likely. In non-high probability a normal D-dimer excludes PE; otherwise the ESC 2019 algorithm continues with CTPA. |
| ≥ 5 — high clinical probability | PE likely. ESC 2019 places CTPA as the next diagnostic step in this group; D-dimer is not used to exclude PE here. |
What is the Revised Geneva score (simplified)?
The revised Geneva score estimates how likely pulmonary embolism is before any test, using only history and bedside findings — no physician gestalt item. Le Gal and colleagues derived the weighted version in Geneva emergency patients in 2006; Klok and colleagues showed in 2008, in 1,049 patients from two European management studies, that giving each item one point (two for heart rate ≥ 95/min) keeps the same accuracy.
When to use it
- Haemodynamically stable patient with suspected acute PE, before ordering D-dimer or CTPA.
- When you want a fully objective rule that does not depend on judging whether PE is the most likely diagnosis.
- To decide whether a D-dimer result can exclude PE (non-high probability) or imaging is needed directly (high probability).
- Combined with the age-adjusted D-dimer cut-off in patients over 50.
When not to use it
- Haemodynamically unstable patients (shock, hypotension) — ESC 2019 uses a separate pathway for suspected high-risk PE (bedside echocardiography or CTPA).
- Pregnancy, where a pregnancy-adapted pathway is used instead.
- Patients already on therapeutic anticoagulation, in whom the rule and D-dimer were not validated.
How it is calculated
| Criterion | Points |
|---|---|
| Age > 65 years | +1 |
| Previous DVT or PE | +1 |
| Surgery (general anaesthesia) or lower-limb fracture within the past month | +1 |
| Active malignancy (solid or haematological; active or considered cured < 1 year) | +1 |
| Unilateral lower-limb pain | +1 |
| Haemoptysis | +1 |
| Heart rate | |
| < 75 /min | 0 |
| 75–94 /min | 1 |
| ≥ 95 /min | 2 |
| Pain on deep venous palpation of the lower limb and unilateral oedema | +1 |
Clinical pearls and limitations
- Simplified version: heart rate ≥ 95 /min scores 2, every other item 1. Do not mix with the original weighted Geneva score (cut-offs 0–3 / 4–10 / ≥ 11). Two-level reading: 0–2 PE unlikely, ≥ 3 PE likely. Only for haemodynamically stable patients.
- Heart rate is the only graded item: < 75/min 0, 75–94/min 1, ≥ 95/min 2.
- Two readings exist: three-level (0–1 low, 2–4 intermediate, ≥ 5 high) and two-level (0–2 unlikely, ≥ 3 likely). Pick one per pathway.
- The leg item needs both pain on deep venous palpation and unilateral oedema; unilateral leg pain alone is a separate item.
- Fully standardised items make the score reproducible between junior and senior doctors.
Frequently asked questions
What is the difference between the original and the simplified Geneva score?
The original weights items from 1 to 5 points (cut-offs 0–3, 4–10, ≥ 11). The simplified version scores each item 1 point, except heart rate ≥ 95/min with 2 points, and uses cut-offs 0–1, 2–4 and ≥ 5. Accuracy was the same in Klok 2008.
Geneva or Wells for pulmonary embolism?
Both are endorsed by ESC 2019 and AWMF 2023 and perform similarly. Geneva is fully objective; Wells includes the subjective item 'PE most likely diagnosis'. Use the one your local pathway is built on.
Can a low Geneva score rule out PE on its own?
No. A low or intermediate score must be combined with a normal D-dimer to exclude PE without imaging.
Evidence and guidelines
- Primary source: Klok FA et al. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med 2008;168(19):2131-2136.
- 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.
- ESC 2019 acute PE guideline, Table 5 (original and simplified revised Geneva rule; three-level and two-level cut-offs).
- AWMF S2k 065-002 (2023), Tab. 3.2 and Empfehlung 3.2.
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Ask Medelix about the Revised Geneva score (simplified)Related calculators
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- YEARS algorithmRule out pulmonary embolism with a D-dimer threshold adapted to three clinical items
- Age-adjusted D-dimer cut-offD-dimer threshold for excluding PE in patients over 50 (age × 10 µg/L)
- PERC rulePulmonary Embolism Rule-out Criteria — skip D-dimer when gestalt probability is already low
- sPESI (simplified Pulmonary Embolism Severity Index)30-day mortality risk in confirmed acute pulmonary embolism
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