Geneva Score PE Calculator

Geneva Score PE Calculator for Pulmonology. In the three-tier weighted scheme, 0-3 points is low probability (roughly 8% PE prevalence), 4-10 is intermediate (about 28%), and 11 or more is high (about 74%). A low or intermediate probability combined with a negative high-sensitivity D-dimer safely excludes PE without imaging, whereas high probability warrants proceeding directly to CT pulmonary angiography regardless of D-dimer. A two-tier "PE-unlikely" (0-5) versus "PE-likely" (6 or more) dichotomy can also be used with D-dimer. The simplified version uses 0-1 (low), 2-4 (intermediate), 5 or more (high), or a 0-2 versus 3+ dichotomy; both weighted and simplified forms performed equivalently and failed to detect PE in essentially no patients ruled out by score plus normal D-dimer.

How this calculator works

The revised Geneva score estimates the pre-test clinical probability of acute pulmonary embolism using eight purely objective, bedside variables — no arterial blood gas or chest radiograph required, unlike the original 2001 rule. In the standard weighted version, points are assigned to age over 65 (1), prior DVT or PE (3), surgery or lower-limb fracture within one month (2), active malignancy (2), unilateral lower-limb pain (3), haemoptysis (2), heart rate 75-94/min (3) or 95/min or higher (5), and pain on deep palpation of a limb vein with unilateral oedema (4). The points are summed and mapped to a probability tier. A simplified version assigns 1 point to every item (heart rate 95+ scores 2), retaining equivalent discrimination.

When to use this calculator

Apply this score to non-pregnant adults presenting to the emergency department or acute setting with suspected PE, before imaging, to structure the decision between D-dimer testing and CT pulmonary angiography. Its main strength is that every item is objective, so it is well suited to standardised protocols and to clinicians less comfortable estimating gestalt probability. It should not be used to risk-stratify patients with already-confirmed PE (use sPESI or the ESC severity model for that), and it has not been validated in pregnancy, where the YEARS or pregnancy-adapted Geneva algorithms are preferred.

Inputs used

  • Age
  • Previous DVT or PE
  • Recent surgery or fracture
  • Active malignancy
  • Unilateral leg pain
  • Hemoptysis
  • Heart rate
  • Leg pain on palpation and unilateral edema

Clinical interpretation

In the three-tier weighted scheme, 0-3 points is low probability (roughly 8% PE prevalence), 4-10 is intermediate (about 28%), and 11 or more is high (about 74%). A low or intermediate probability combined with a negative high-sensitivity D-dimer safely excludes PE without imaging, whereas high probability warrants proceeding directly to CT pulmonary angiography regardless of D-dimer. A two-tier "PE-unlikely" (0-5) versus "PE-likely" (6 or more) dichotomy can also be used with D-dimer. The simplified version uses 0-1 (low), 2-4 (intermediate), 5 or more (high), or a 0-2 versus 3+ dichotomy; both weighted and simplified forms performed equivalently and failed to detect PE in essentially no patients ruled out by score plus normal D-dimer.

Worked example

A 70-year-old man (age over 65: 1) with active lung cancer (2), presenting with unilateral right calf pain (3) and a heart rate of 88/min (3), no haemoptysis, no recent surgery, no prior VTE, and no pain on venous palpation, scores 9 points. This falls in the intermediate-probability tier (4-10 points), where PE prevalence was about 28% in the validation cohort. He is not low-risk enough for a standard D-dimer to exclude PE reliably, so he proceeds to CT pulmonary angiography (or an age-adjusted D-dimer strategy) rather than being discharged on a negative conventional D-dimer alone.

Limitations and safety notes

The score was derived and validated in emergency-department populations, so its calibration in inpatients, ICU patients, and primary care is less certain. It must always be paired with D-dimer to exclude PE — the low-probability tier still carries roughly 8% prevalence, far too high to withhold testing on the score alone. It is a diagnostic (pre-test) rule only and says nothing about PE severity or prognosis. It has not been validated in pregnancy, and the heart-rate thresholds can shift the tier substantially, so tachycardia from any cause (pain, fever, sepsis) may inflate the probability.

Frequently asked questions

How does the revised Geneva score differ from the Wells score?

Both estimate pre-test PE probability, but the revised Geneva score uses only objective, reproducible variables, whereas Wells includes the subjective item 'PE is the most likely diagnosis.' In head-to-head prospective comparison the two rules (and their simplified versions) performed equivalently for safely excluding PE when combined with D-dimer.

Weighted or simplified version — which should I use?

Either is acceptable. The simplified revised Geneva score assigns 1 point per item (2 for heart rate 95+) and showed the same diagnostic accuracy (ROC AUC ~0.74 vs 0.75) and clinical utility, so it can reduce arithmetic errors at the bedside without loss of safety.

Can a low score alone rule out PE?

No. Even the low-probability tier carries roughly 8% PE prevalence. The score must be combined with a negative high-sensitivity (ideally age-adjusted) D-dimer to safely exclude PE without imaging; a high-probability score should go straight to CT pulmonary angiography.

Is it valid in pregnancy?

It was not derived or validated in pregnant patients. Pregnancy-specific pathways such as the pregnancy-adapted YEARS algorithm or the pregnancy-adapted Geneva rule should be used instead.

Does the score predict how severe the PE is?

No. It is purely a diagnostic pre-test probability tool. For prognosis and severity stratification of confirmed PE, use sPESI or the ESC risk model incorporating haemodynamics, RV dysfunction, and troponin.

References

  • Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, Perrier A. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006. PMID: 16461960.
  • Klok FA, Mos ICM, Nijkeuter M, Righini M, Perrier A, Le Gal G, Huisman MV. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med. 2008. PMID: 18955643.
  • Douma RA, Mos ICM, Erkens PMG, et al. Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism: a prospective cohort study. Ann Intern Med. 2011. PMID: 21646554.
  • Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020. PMID: 31504429.

Editorial review and citation methodology

Reviewed by the Quick Medical Calculator Editorial Team. Last reviewed: April 7, 2026. The review checks calculator inputs, intended population, interpretation, limitations, and source alignment.

  • Prefer original validation studies for scoring systems and prediction tools.
  • Use current specialty society guidance, transplant allocation policy, public health guidance, or regulator resources when they govern clinical use.
  • Include limitations and safety notes when a calculator is population-specific, context-dependent, or unsuitable as a standalone decision tool.

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