How this instrument works
The Revised Geneva score adds eight findings, each with a fixed point value set by how strongly it predicted PE in the derivation study: age over 65 (1 point), a prior DVT or PE (3), recent surgery or a lower-limb fracture within a month (2), active malignancy (2), unilateral leg pain (3), hemoptysis (2), a heart rate of 75 to 94 (3) or 95 and above (5), and pain on deep leg palpation together with unilateral edema (4). Every criterion is a yes/no or a fixed lookup — nothing asks the examiner to weigh how likely PE feels overall. Summed, the arithmetic maximum is 22, though a patient triggering every single item at once is an unusual, rarely seen combination in practice.
Le Gal, Righini, Roy, and colleagues derived and validated the score in a 2006 Annals of Internal Medicine study of emergency-department patients with suspected PE, deliberately reworking an earlier Geneva score to drop anything requiring arterial blood gas results or a chest X-ray reading, leaving only findings available from history, vitals, and physical exam. Their cohort split into three probability tiers with published PE prevalence attached to each: low, 0 to 3 points, carried roughly 8% prevalence; intermediate, 4 to 10, roughly 28%; and high, 11 or above, roughly 74%.
Set this beside the Wells score, the other PE probability tool on this site, and the design difference is the whole point of the Revised Geneva score's existence. Wells asks a clinician to judge whether PE is the leading diagnosis — a genuine, useful piece of clinical gestalt, but one that can shift between two different examiners looking at the same patient. Every input here instead comes from a chart-confirmable fact: a birth date, a heart-rate reading, a documented surgery date. Two clinicians working from the same records should land on the same Geneva total even if they'd disagree on a Wells score for the identical patient.
- Toggle Age over 65, worth 1 point.
- Toggle Previous DVT or PE (3 points) and Active malignancy (2 points).
- Toggle Surgery or fracture of the lower limb within the past month, worth 2 points.
- Toggle Unilateral lower-limb pain (3 points) and Hemoptysis (2 points).
- Select Heart rate — under 75 scores 0, 75-94 scores 3, 95 or more scores 5.
- Toggle Pain on deep venous palpation with unilateral edema, worth 4 points, then read the total.
Worked example — 16 points versus 8 points
A patient over 65 with a prior DVT or PE (3), unilateral leg pain (3), a heart rate of 95 or higher (5), and pain on leg palpation with edema (4), but no recent surgery, malignancy, or hemoptysis: 1 + 3 + 0 + 0 + 3 + 0 + 5 + 4 = 16, comfortably inside the high-probability tier (≥11), the band the 2006 derivation cohort linked to roughly 74% PE prevalence.
A second patient, also over 65, with recent surgery (2) and active malignancy (2) and a heart rate of 75 to 94 (3), but no prior VTE, leg pain, hemoptysis, or palpation findings: 1 + 0 + 2 + 2 + 0 + 0 + 3 + 0 = 8, squarely in the intermediate tier (4 to 10), around 28% prevalence in that same cohort — roughly a third the probability of the first patient despite four criteria being positive in each case.
Questions
What does a Revised Geneva score of 16 indicate?
It places a patient in the high-probability tier, 11 points or above, which the 2006 derivation cohort by Le Gal and colleagues associated with roughly 74% PE prevalence among patients who scored that high. That figure describes the study population it came from, not a personal probability for any individual patient, but it's the number clinicians commonly cite when discussing this tier.
What are the Revised Geneva score risk tiers?
Low probability spans 0 to 3 points, associated with roughly 8% PE prevalence in the derivation study; intermediate spans 4 to 10, around 28%; and high covers 11 points and above, around 74%. All three figures come from Le Gal et al.'s 2006 Annals of Internal Medicine cohort and describe that study population's outcomes rather than a guaranteed rate for any new patient.
Why is heart rate scored on three levels instead of yes/no?
It's the one criterion in the Revised Geneva score with three tiers rather than a simple presence-or-absence check: under 75 beats per minute contributes nothing, 75 to 94 contributes 3 points, and 95 or above contributes 5. The derivation data showed tachycardia's association with PE scaled with how fast the heart rate actually ran, so the scoring reflects that gradient instead of collapsing it into a single cutoff.
Why is the Revised Geneva score considered more objective than Wells?
Every input here is a fact a clinician can confirm from a chart or a monitor — an age, a surgery date, a heart-rate reading — with no item asking for an overall clinical impression. The Wells score, by contrast, includes a criterion worth 3 of its 12.5 points that depends on whether the examiner judges PE the leading diagnosis, which can reasonably differ between two clinicians assessing the same patient. Le Gal's team built the Geneva revision specifically to remove that kind of judgment call.
Can the Revised Geneva score really total 22 points?
Arithmetically, yes — summing every criterion's maximum weight gives 22. In practice, a patient who triggers all eight findings simultaneously, including both the highest heart-rate tier and a positive leg-palpation exam alongside active malignancy and a prior clot, is an unusual, rarely encountered combination. The published probability tiers only run up to '11 or above,' so scores well past 11 are read the same way as a 16 or an 18: high probability.
Who is the Revised Geneva score meant to be used by?
It's a clinical decision-support tool for trained clinicians working up a patient with suspected pulmonary embolism, meant to sit alongside a D-dimer test or imaging rather than replace either. It isn't built for a patient to score themselves at home — several items, like unilateral edema on deep palpation, require a hands-on physical exam to assess accurately.
References
- Le Gal, Righini, Roy et al. 2006, Ann Intern Med — Revised Geneva score derivation (PubMed)
- MedlinePlus — Pulmonary Embolism
Read this first: This instrument computes a screening figure from population formulas — it is not a diagnosis, and it cannot see the whole picture a clinician can. Use it to inform a conversation, not to replace one.