Geneva Score (Revised) for Pulmonary Embolism

The rGeneva score is an accepted alternative to the Wells’ PE criteria used to risk-stratify patients with concern for PE. This tool does not incorporate gestalt, which some would argue is better than any clinical decision rule.

In the setting of concern for possible PE:

• The patient is considered low risk (Score 0-3), <10% incidence of PE.
• The patient is considered intermediate risk (Score 4-10).
  • If d-dimer testing is negative, consider stopping workup.
  • If d-dimer testing is positive, consider CT and US.
    • If CT is inconclusive, consider V/Q scan or angiography.
• If the patient is considered high risk (score 11+, >60% incidence of PE), consider CT and US.
  • If imaging is negative consider angiography.

• No decision rule should trump clinical gestalt. High clinical suspicion for PE should warrant imaging regardless of Geneva score.
• Never delay resuscitative efforts for diagnostic testing, especially in the unstable patient.
• History and exam should always be performed prior to diagnostic testing.