Revised Geneva Score Calculator (clinical probability of pulmonary embolism)

Understanding the revised Geneva score calculator — concept and principle

The revised Geneva score estimates the clinical probability of pulmonary embolism (PE) before any imaging, using only history and examination. Emergency doctors use it to decide whether a D-dimer test can rule PE out or whether CT pulmonary angiography is needed.

Points from history and pulse: with the default inputs the result is 7 points (intermediate (4–10)).

How it is calculated

Score (0–22) = sum of:

Age over 65: 1
Previous deep vein thrombosis or PE: 3
Surgery under general anaesthesia or leg fracture within 1 month: 2
Active cancer: 2
Pain in one leg only: 3
Coughing up blood: 2
Heart rate 75–94: 3; 95 or more: 5
Pain on pressing the leg veins with swelling of one leg: 4

Categories: 0–3 low, 4–10 intermediate, 11 or more high probability.

The principle

Le Gal and colleagues (2006) built the score from patients assessed for suspected PE in emergency departments, choosing items that predicted PE independently and could be assessed objectively. Unlike the Wells score, it contains no item asking whether PE is the most likely diagnosis, which makes it more standardised between doctors. Signs of a leg clot and a fast heart rate carry the most weight.

Worked example

Default inputs: age over 65, pain in one leg, heart rate 88; everything else no.

Age over 65 = 1.
One-sided leg pain = 3.
Heart rate 88 is in 75–94 = 3.
Total = 1 + 3 + 3 = 7 → Intermediate (4–10).

How to read the result

Where does your result fall?

With low or intermediate probability, a negative D-dimer can safely rule out PE in most patients. With high probability, imaging (usually CT pulmonary angiography) is done directly, because a negative D-dimer is not reassuring enough. The score is used alongside clinical assessment, not instead of it.

Common mistakes

Using the score in patients already known to have PE.
Counting bilateral leg pain as unilateral.
Ordering a D-dimer in high-probability patients and being falsely reassured by a negative result.

Keep in mind: This is a classification aid for clinicians, not a diagnosis. Sudden breathlessness, chest pain or coughing blood needs emergency care.

Frequently asked questions

What is the difference between Geneva and Wells scores?

Wells includes a subjective item about whether PE is the most likely diagnosis; revised Geneva uses only objective items.

Can a D-dimer rule out PE?

A negative D-dimer rules it out in most patients with low or intermediate probability.

Is there a simplified version?

Yes, the simplified revised Geneva score gives 1 point per item.

Sources: Le Gal G, Righini M, Roy PM, et al., "Prediction of pulmonary embolism in the emergency department: the revised Geneva score", Ann Intern Med 2006;144(3):165–171

Checked 9 Nov 2026. Le Gal G, Righini M, Roy PM, et al., “Prediction of pulmonary embolism in the emergency department: the revised Geneva score”, Ann Intern Med 2006;144(3):165–171 — items, points and probability categories as listed in the MSD Manual Professional calculator “Revised Geneva Score for Estimation of the Clinical Probability of Pulmonary Embolism in Adults”.

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