Geneva Score Calculator

Score the eight revised Geneva variables and see whether suspected pulmonary embolism is low, intermediate, or high probability.

What it does

The revised Geneva score estimates the pretest probability of pulmonary embolism in adults with suspected disease. It uses eight clinical variables that are available before imaging. The score helps decide whether to start with a D-dimer, proceed to CT pulmonary angiography, or consider another pathway.

The variables are age older than 65, previous deep vein thrombosis or pulmonary embolism, surgery or fracture within the past month, active cancer, unilateral lower limb pain, hemoptysis, heart rate, and pain on deep leg palpation with unilateral edema. Heart rate is scored in two bands: 75 to 94 beats per minute adds 3 points, and 95 or higher adds 5.

The total runs from 0 to 25. A score of 0 to 3 is low probability, 4 to 10 is intermediate, and 11 or more is high. In the original validation, the proportion of patients with confirmed pulmonary embolism rose across these bands. The score is not a rule out test and does not replace clinical judgment in an unstable patient.

The revised version removed a few items from the original Geneva score and changed some weights. It performs similarly to the Wells score in many studies. The choice between them often depends on local practice and on whether the clinician wants a score that relies only on objective variables. The revised Geneva score does not require a subjective judgment about whether pulmonary embolism is more likely than an alternative diagnosis.

The score is used in emergency departments, inpatient wards, and outpatient clinics. It assumes the patient is hemodynamically stable enough for a diagnostic pathway. A patient with hypotension, syncope, or signs of right heart strain needs urgent assessment and should not wait for a score. Pregnancy and kidney disease also require separate pathways because D-dimer and CT have different roles.

How to use

1. Confirm that pulmonary embolism is a plausible diagnosis and that the patient is stable enough for a diagnostic pathway.
2. Check age. Add 1 point if the patient is older than 65.
3. Add 3 points for previous deep vein thrombosis or pulmonary embolism, 2 for surgery or fracture in the past month, and 2 for active cancer.
4. Add 3 points for unilateral lower limb pain, 2 for hemoptysis, and 4 for pain on deep leg palpation with unilateral edema.
5. Measure the heart rate. Add 3 points for 75 to 94 beats per minute or 5 points for 95 or higher.
6. Total the points, assign the band, and follow the local pathway for D-dimer or imaging.

Formula

Age

1 point when age is older than 65.

Prior VTE

3 points for previous deep vein thrombosis or pulmonary embolism.

Surgery or fracture

2 points for surgery or fracture within the past month.

Active cancer

2 points for active cancer.

Leg pain

3 points for unilateral lower limb pain.

Hemoptysis

2 points for coughing blood.

Heart rate

3 points for 75 to 94 beats per minute, 5 points for 95 or higher.

Palpation and edema

4 points for pain on deep leg palpation with unilateral edema.

Use the highest applicable heart rate band, not both. The age item is older than 65, so a patient who is exactly 65 does not receive the point. Active cancer means cancer that is diagnosed or under treatment, not a remote history in remission. The score is for suspected pulmonary embolism in a stable patient. It does not apply to patients with ST elevation, shock, or another condition that requires immediate treatment.

Worked example

Reference table

Limits

• The score estimates pretest probability. It does not confirm or exclude pulmonary embolism.
• It was validated in stable patients and should not delay treatment in an unstable patient.
• Pregnancy, kidney disease, and contrast allergy require separate imaging and D-dimer pathways.
• The score does not include all risk factors, such as immobilization or estrogen use, so clinical judgment still matters.

Common mistakes

• Adding both heart rate bands instead of using the highest one that applies.
• Giving the age point at exactly 65. The item is older than 65.
• Counting a remote cancer in remission as active cancer.
• Using the score to rule out pulmonary embolism without a D-dimer or imaging pathway.
• Applying the score to a hemodynamically unstable patient instead of arranging urgent care.

Try it yourself

Quick checks. Answers sit tucked under each question.

Questions

Sources

• Original revised Geneva score study in Annals of Internal Medicine
• Diagnostic accuracy of D-dimer testing and the revised Geneva score

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