Clinical probability of PE (Revised Geneva Score)
Primary source: Le Gal G et al. Ann Intern Med 2006; 144(3): 165-171
The revised Geneva score (Le Gal G et al., Ann Intern Med, 2006) is an alternative to the Wells score for estimating the pretest probability of PE. Its main advantage is the absence of the subjective item "PE is more likely than an alternative diagnosis," which makes it more reproducible across clinicians of varying experience.
The score uses 8 parameters: age > 65 years (1), prior DVT/PE (3), surgery or fracture within the past month (2), active malignancy (2), unilateral lower limb pain (3), hemoptysis (2), heart rate 75-94/min (3), heart rate ≥ 95/min (5), pain on calf palpation with unilateral edema (4).
Interpretation: 0-3 points - low probability, 4-10 - intermediate, ≥ 11 - high. A simplified two-level version also exists: 0-5 - PE unlikely, ≥ 6 - PE likely. This score is recommended by the ESC 2019 guidelines alongside the Wells score.
72-year-old man with active colon cancer on chemotherapy. Reports dyspnea for 2 days. Heart rate 102/min, BP 130/85, SpO₂ 93%. Left calf swollen and tender on palpation. No hemoptysis.
Age > 65 (1) + malignancy (2) + heart rate ≥ 95 (5) + calf tenderness with unilateral edema (4) = 12 points.
High pretest probability. Proceed directly to CT pulmonary angiography without waiting for D-dimer. Simultaneously obtain lower extremity duplex ultrasound. If contrast is contraindicated, consider ventilation-perfusion scintigraphy.
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