When and why this update was necessary now.
The revised Geneva score has been used clinically for over 10 years, but it still remains valid and clinically relevant. MDCalc talked to the lead clinician-researcher, Grégoire Le Gal, MD, PhD, who developed the score about how and why to use it.
Why did you develop the revised Geneva score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?
I developed the revised Geneva score as part of a research project when working as a fellow in the team of Professors Bounameaux, Perrier and Righini at Geneva University Hospital in Switzerland. The previous version of the Geneva worked well, but required an arterial blood gas analysis, which in daily practice was less and less often used, limiting the applicability of the score. Another objective was that the score would be fully standardized, i.e., without any variable requiring physician’s gestalt assessment.
What pearls, pitfalls and/or tips do you have for users of the score? Do you know of cases when it has been applied, interpreted or used inappropriately?
It’s important to remember that it has not been validated in inpatients with suspected PE.
In contrast with other clinical decision rules for PE, all patients with a low or intermediate pretest probability can undergo a D-dimer test, which will rule out PE if negative.
Also, the score uses both symptoms (reported leg pain) and signs (pain with palpation and edema). Note that to give points related to signs of DVT, both pain with palpation and edema should be present.
How do you use the score in your own clinical practice? Can you give an example of a scenario in which you use it?
I consider it pretty much in all patients with a clinical suspicion of PE. I only do the score (and the D-dimer test if the score is non-high) in patients in whom I am ready to order a CTPA should the score be high probability or the D-dimer positive.
Any other research in the pipeline that you’re particularly excited about?
Interesting developments have been the PERC Rule, which is aimed at assessing patients with chest pain or shortness of breath who could safely forego any testing (not even a D-dimer test). Also, the development of the Age-Adjusted D-dimer test further increased the yield of non-invasive testing, and was proven safe to use in combination with the revised Geneva score.
The Revised Geneva Score is available at MDCalc on the web at https://www.mdcalc.com/geneva-score-revised-pulmonary-embolism, and on MDCalc’s iOS and Android apps.
Grégoire Le Gal, MD, PhD, is a professor in the Division of Hematology at the University of Ottawa, a physician in the Thrombosis Program at Ottawa Hospital, and a Senior Scientist in the Ottawa Hospital Research Institute, Clinical Epidemiology Program in Ottawa, Canada. He has 330 peer-reviewed publications, and research interests include the diagnosis and management of venous thromboembolism (VTE) and the derivation and validation of clinical decision rules for VTE.