Geneva Score

The Geneva score is a clinical prediction rule used in determining the pre-test probability of pulmonary embolism (PE) based on a patient's risk factors and clinical findings. It has been shown to be as accurate as the Wells Score, and is less reliant on the experience of the doctor applying the rule. The Geneva score has been revised and simplified from its original version. The simplified Geneva score is the newest version for the general population, and predicted to have the same diagnostic utility as the original Geneva score. A version of the revised score was modified to be applicable to pregnant patients.

Original Geneva Score

The original Geneva score was developed in 2001 in Geneva, Switzerland.

It's calculated using 7 risk factors and clinical variables:

The score obtained relates to the probability of the patient having had a pulmonary embolism (the lower the score, the lower the probability):

* <5 points indicates a low probability of PE (10%)
* 5 - 8 points indicates a moderate probability of PE ( 38%)
* >8 points indicates a high probability of PE. (81%)

Revised Geneva Score

More recently, the revised Geneva score has been introduced. This simplifies the scoring process, and has also been shown to be as effective as the Wells score.

The revised score uses 8 parameters, but does not include figures which require an arterial blood gas sample to be performed:

The score obtained relates to probability of PE:

* 0 - 3 points indicates low probability (8%)
* 4 - 10 points indicates intermediate probability (29%)
* 11 points or more indicates high probability (74%)

The probabilities derived from the scoring systems can be used to determine the need for, and nature of, further investigations such as D-dimer, ventilation/perfusion scanning and CT pulmonary angiography to confirm or refute the diagnosis of PE.

Simplified Geneva Score

A newer revision referred to as the simplified revised Geneva score has been prospectively studied and reported in the Archives of Internal Medicine on October 27 of 2008. The simplified scoring system replaced the weighted scores for each parameter with a 1-point score for each parameter present to reduce the likelihood of error when the score is used in a clinical setting. The report noted that the simplified Geneva score does not lead to a decrease in diagnostic utility in evaluating patients for a PE when compared to previous Geneva scores.

The simplified Geneva score:

Patients with a score of 2 or less are considered unlikely to have a current PE. Authors suggest that the likelihood of patients having a PE with a simplified Geneva score less than 2 and a normal D-Dimer is 3 percent. Login to free text may be required.

Pregnancy Adapted Geneva (PAG)

In 2021, the items of the Revised Geneva Score were re-evaluated on pregnant women. Some items were removed, and the threshold values for the remaining items were modified to better discriminate patients even with the altered physiologic baseline of pregnancy (e.g. higher cut-off value for heart rate, lower cut-off value for age). The ROC for the resulting score had an AUC of 0.795 (CI 0.690–0.899) according to the authors, which is similar to (and even better than) the Revised Geneva Score. It's important to note, that this AUC was measured in the pregnant population, and the score was not ''generalized'' to include pregnant patients, but ''modified'' for the characteristics of pregnant patients. It's not tested on non-pregnant patients.

Patients are categorized in 3 pre-test probability groups:

* 0-1 points: low risk ( <10% risk of PE)
* 2-6 points: intermediate risk ( 10-50% risk of PE)
* >6 points: high risk ( >50% risk of PE

References

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External links

Online Calculator of the Revised Geneva Score

Diagnostic emergency medicine
Diagnostic intensive care medicine
Medical scoring system