Geneva score

Source:

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%)

In 2006 the revised Geneva score was introduced.{{cite journal | vauthors = Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, Perrier A | title = Prediction of pulmonary embolism in the emergency department: the revised Geneva score | journal = Annals of Internal Medicine | volume = 144 | issue = 3 | pages = 165–171 | date = February 2006 | pmid = 16461960 | doi = 10.7326/0003-4819-144-3-200602070-00004 | s2cid = 28777714 }} This simplifies the scoring process, and has also been shown to be as effective as the Wells score.{{cite journal | vauthors = Righini M, Le Gal G, Aujesky D, Roy PM, Sanchez O, Verschuren F, Rutschmann O, Nonent M, Cornuz J, Thys F, Le Manach CP, Revel MP, Poletti PA, Meyer G, Mottier D, Perneger T, Bounameaux H, Perrier A | display-authors = 6 | title = Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial | journal = Lancet | volume = 371 | issue = 9621 | pages = 1343–1352 | date = April 2008 | pmid = 18424324 | doi = 10.1016/S0140-6736(08)60594-2 | s2cid = 16539686 }}

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.

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.{{cite web |url=http://firstwatch.jwatch.org/cgi/content/full/2008/1029/1 |title=Geneva Scoring for Pulmonary Embolism Simplified Further. Physician's First Watch October 29, 2008 |access-date=January 25, 2009 }} Login to free text may be required.

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

{{reflist}}

[https://www.evidencio.com/models/show/341 Online Calculator of the Revised Geneva Score]

Category:Diagnostic emergency medicine

Category:Diagnostic intensive care medicine

Category:Medical scoring system