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    Bova Score for Pulmonary Embolism Complications

    Predicts 30-day risk of PE-related complications in hemodynamically stable patients.
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    INSTRUCTIONS

    Use ONLY in hemodynamically stable patients (sBP ≥90) with confirmed acute PE (pulmonary embolism).

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with confirmed acute PE, defined as:

    • Intraluminal filling defect on PE protocol spiral CT, or
    • Positive V/Q scan, or
    • Normal or inconclusive CT or V/Q scan and positive lower extremity ultrasound.

    Do not use in hemodynamically unstable patients (sBP <90 mmHg).

    • The Bova Score risk stratifies normotensive patients with confirmed PE to identify patients at intermediate and high risk for complications and mortality associated with PE.
    • Use only in patients who are hemodynamically stable (sBP ≥90 mmHg).
    • Accounts for right ventricular dysfunction and cardiac biomarkers, unlike other scoring systems for PE.
    • Differs from the PESI (and sPESI), which were specifically designed to identify patients at low risk for mortality.
    • Use variables obtained at the time of diagnosis of acute PE.
    • Requires troponin and transthoracic echocardiography (TTE) or CT scan to assess for right ventricular dysfunction.
    • In normotensive patients, identifying those at high risk for PE-related events can be challenging.
    • The European Society of Cardiology recommends stratifying patients with PE in a stepwise approach using right ventricular dysfunction and cardiac biomarkers as part of the risk assessment. The Bova Score looks at both right ventricular dysfunction and cardiac biomarkers.  
    • Other clinical models (e.g. sPESI, Hestia Criteria) identify low-risk patients who may be candidates for outpatient therapy, but may not identify well-appearing patients who are at high risk and may benefit from escalated care (e.g. thrombolysis, ICU management).
    • May identify intermediate low and intermediate high (previously submassive) risk PE patients who benefit from advanced therapy.
    >100 mm Hg
    0
    90-100 mmHg
    +2
    No
    0
    Yes
    +2
    No
    0
    Yes
    +2
    <110
    0
    ≥110
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Risk of PE-related complications (death from PE, hemodynamic collapse, or recurrent nonfatal PE) increases in patients with higher Bova Score.
    • Consider assessing high-risk patients for advanced therapy in addition to anticoagulation (catheter-directed therapy, thrombolytic therapy, IVC filter placement) if warranted.
    • Consider monitoring patients with intermediate and high risk Bova Scores in a higher level of care (stepdown unit, ICU).
    • Consider standard treatment (anticoagulation alone) for patients with a low risk Bova Score.

    Management

    • Optimal management of intermediate risk patients with acute PE is unclear, but escalation of care (e.g. thrombolysis, referral to ICU) should be considered in patients who are not low risk.
    • Consider multidisciplinary discussion regarding treatment options for patients with a high risk (>4) Bova Score.

    Critical Actions

    • High risk patients (stage III) should be monitored closely and a plan for rescue therapy should be made in case of clinical deterioration.
    • Stage III patients may warrant multidisciplinary discussion regarding management.
    • Additional findings and pathology not included in the Bova Score should also be considered, such as respiratory rate, need for respiratory support, SpO₂, syncope, elevated lactic acid, coexisting DVT, and other underlying chronic comorbidities.
    • The Bova Score does not predict risks of therapy such as bleeding with thrombolytic therapy or anticoagulation.
    Content Contributors
    Reviewed By
    • Robyn Scatena, MD
    About the Creator
    Dr. Carlo Bova
    Content Contributors
    Reviewed By
    • Robyn Scatena, MD