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Revised Geneva Score Calculator for Pulmonary Embolism

The Revised Geneva Score from 2006 is a simple tool that helps us to predict Pulmonary Embolism... It does not rely on the experience of a doctor as much as the Wells Score calculator, and the Revised Geneva Score is also simpler and easier to apply than the original Geneva Score, since it does not require any invasive measurement methods... The Simplified Geneva Score was created in 2008 to make the process even easier to perform, and, most importantly, easier to remember. In the simplified version, almost all of the criteria have the same amount of points: 1. The only exception is that a heart rate over 95/min is counted as 2 points.

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 The GENEVA Scores

The Revised GENEVA score is a clinical prediction rule used to determine the pre-test probability of Pulmonary Embolism [PE] based on a patient's risk factors and clinical findings.

Articles of Interest

Combination of the Simplified Modified Geneva and Wells Clinical Prediction Scoring promise a good performance in pulmonary embolism diagnosis

We found that Wells Clinical Scoring is superior to the Simplified Modified Geneva Score in terms of sensitivity and specificity. The use of these two clinical scores in the outpatient clinic was more useful in excluding PT, while in the emergency department, their combination was more effective in diagnosing it.

Comparing the “simplified revised Geneva score”, the “original PESI”, and the “simplified PESI” for mortality prediction for pulmonary embolism. A 10 years follow-up study

The use of original PESI score could predict the long-term mortality of PE patients more accurately than other scores. These data could have high clinical values.

Diagnostic Accuracy of D-Dimer Testing and the Revised Geneva Score in the Prediction of Pulmonary Embolism

The findings of this study confirm the fact that applying a clinical decision rule in combination with an age-adjusted D-dimer threshold would have increased the number of patients in whom PE could have been spared CTPA. PE would have been ruled out for more than one-half of all suspected cases if the Geneva score alone had been used.

Improving PE workup with the revised Geneva score

MDCalc talked to the lead clinician-researcher, Grégoire Le Gal, MD, PhD, who developed the score about how and why to use it.

Performance of the revised Geneva score in patients with a delayed suspicion of pulmonary embolism

Our observations indicate that it remains safe to use the RGS and a D-dimer test to rule out pulmonary embolism, regardless of the duration of symptoms before a suspicion of pulmonary embolism is raised. However, the efficiency of the RGS was significantly lower for patients with a delayed presentation, although the proportion in whom PE could be excluded without CTPA imaging remained >20%.

Pregnancy-Adapted Geneva Score – Pre-test Probability of Acute PE in Pregnancy

In this prospective cohort, a pregnancy-adapted Geneva Score demonstrated better diagnostic accuracy than the original Geneva Score in identifying pregnant patients as low, intermediate, and high risk for acute pulmonary embolism (PE).

Ruling Out Pulmonary Embolism in the Primary Care Setting

The Geneva score consists of eight objective characteristics, eliminating the physician's subjective judgment. Like the Wells score, each characteristic is assigned a point value, and the cumulative score stratifies patients into different risk categories. There are several versions of the Geneva score (the original, revised, and simplified revised), adjusting point values and risk categories to alter performance.

Simplification of the Revised Geneva Score for Assessing Clinical Probability of Pulmonary Embolism

The revised Geneva score is a fully standardized clinical decision rule (CDR) in the diagnostic workup of patients with suspected pulmonary embolism (PE). The variables of the decision rule have different weights, which could lead to miscalculations in an acute setting. We have validated a simplified version of the revised Geneva score.

Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.

Resources

Geneva Score (Revised) for Pulmonary Embolism

Important to remember that it has not been validated in inpatients with suspected PE. In contrast with other clinical decision rules for PE, all patients with a low or intermediate pretest probability can undergo a D-dimer test, which will rule out PE if negative. Also, the score uses both symptoms (reported leg pain) and signs (pain at palpation and edema). Note that to give points related to signs of DVT, both pain at palpation AND edema should be present.

Physiopedia

The Revised Geneva Score is a clinical prediction rule for pulmonary embolism (PE) developed by Le Gal et al in 2006. Based on patient history and physical exam, it aims to risk-stratify patients into low, intermediate, and high-risk categories. PE is ruled out in low-risk patients through a d-dimer serum test while high-risk patients are to undergo additional imaging studies such as CT angiography and ultrasound.